Nitrostat (nitroglycerin) is used to prevent or treat angina (chest pain) in those who have coronary artery disease. Coronary artery disease describes the condition in which the arteries develop plaque build-up on their inner walls, causing them to become rigid and narrow, restricting blood flow. Angina occurs when the restricted flow is insufficient to supply the heart with oxygen, such as during physical activity, emotional distress, or, sometimes, for no apparent reason.

The medication works by widening and relaxing the constricted blood vessels, improving the flow of blood to the heart.

Using Nitrostat to Manage Angina

Nitrostat should be used as directed by a doctor; however, doctor instructions are usually very similar. As mentioned above there are two ways this medication is used, as a preventative treatment or to manage ongoing angina. Treatment differs slightly between the two.

To prevent angina from occurring:

• Administer one Nitrostat about 5 to 10 minutes prior to physical activity or other scenario in which angina is likely.

To stop angina that is occurring:

• Administer one Nitrostat.
• After 5 minutes, administer a second, if needed.
• After 5 minutes, administer a third, if needed.
• If chest pain has not stopped after the third dose, seek emergency medical attention.
• If chest pain has worsened after the first dose, seek emergency medical attention.

In both cases tablets should be dissolved in the mouth, either under the tongue or in the buccal pouch (between the gums and inner lining of the cheek); they should not be swallowed. Tablets should be taken from a resting position, ideally sitting down.

Ideally the smallest dose that provides benefit should be used to prevent tolerance, and similarly the medication should only be used when needed. For some patients, however, it can be difficult to tell when chest pain is angina or something else, like indigestion. Patients will want to err on the side of safety until the situation is understood.

Drug Interactions

Nitrostat is known to interact with a few other medications, most notably:

• Alcohol
• Aspirin
• Tricyclic antidepressants
• Anticholinergics
• Ergotamine
• PDE-5 inhibitors

Use of Nitrostat with alcohol may cause a dangerously low drop in blood pressure, while use with aspirin may enhance the medication's vosodilatory (widening of blood vessels) and hemodynamic (blood flow) effects.

Tricyclic antidepressants and anticholingergic medications both can impair saliva production, making it difficult for the Nitrostat tablet to be dissolved. This can be alleviated by chewing gum, use of artificial saliva, or fluids.

Patients should avoid ergotomine and related medications while taking Nitrostat. If unavoidable, the patient should be alert for symptoms of ergotism:

• Itching
• Diarrhea
• Pins & needles
• Nausea & vomiting
• Mania or psychosis
• Spasms
• Seizures

Finally, patients should avoid use of PDE-5 inhibitors, which are sometimes given to lower high blood pressure, but more commonly are found in erectile dysfunction medications like Cialis or Viagra. Taken together, these drugs can reduce blood pressure to dangerously low levels and also decrease the effects of Nitrostat.

Side Effects

The number one most-commonly reported side effect from Nitrostat is actually a sign the medication is working: headache. Headaches can be treated with over-the-counter medications like acetaminophen once the Nitrostat has worked. If headaches are persistant or very severe, consult a doctor.

Other side effects include:

• Dizziness
• Lightheadedness
• Flushing
• Nausea
• Burning or tingling under the tongue

Very rarely more serious side effects occur; seek emergency medical attention if:

• Fainting
• Fast heartbeat
• Pounding heartbeat
• Irregular heartbeat

Some individuals are allergic to Nitrostat. Seek emergency medical attention if experiencing any of the symptoms of an allergic reaction; rash, severe dizziness, difficulty breathing, swelling or itching of the face or throat.