Nitroglycerin 0.4mg Sub Tabs 100s

Nitroglycerin is converted to nitric oxide (NO) in vascular smooth muscle cells. NO activates guanylate cyclase, increasing intracellular cyclic guanosine monophosphate (cGMP), which leads to dephosphorylation of myosin light chains and relaxation of smooth muscle. This results in systemic vasodilation, primarily of veins, leading to decreased preload and reduced myocardial oxygen demand. It also causes coronary artery vasodilation, improving oxygen supply to ischemic areas.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Abnormal heartbeat (fast, slow, or irregular)
Flushing
Blurred vision
Dry mouth
Excessive sweating
Pale skin
Severe nausea or vomiting
Restlessness
Feeling extremely tired or weak

Other Possible Side Effects

Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor:

Dizziness or headache
Mouth tingling
Burning sensation

This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced.
Certain health conditions, including:
+ Anemia
+ Increased pressure in the head, which can be caused by bleeding in the brain or a head injury
+ A recent heart attack
+ Heart problems
+ Low blood volume
* If you are taking any of the following medications:
+ Avanafil
+ Riociguat
+ Sildenafil
+ Tadalafil
+ Vardenafil
+ Dihydroergotamine
+ Ergonovine
+ Ergotamine
+ Methylergonovine

Please note that this is not an exhaustive list of all potential interactions. To ensure your safety, it is crucial to discuss all of your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. Before starting, stopping, or changing the dose of any medication, consult with your doctor to confirm that it is safe to do so in conjunction with this medication.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

When starting this medication, avoid driving and other activities that require alertness and clear vision until you understand how it affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when climbing stairs.

Follow your healthcare provider's instructions for monitoring your blood pressure. Additionally, be aware that this medication may interfere with certain laboratory tests, so it is crucial to notify all your healthcare providers and laboratory personnel that you are taking this drug.

Avoid consuming alcohol while on this medication. If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.

Be aware that taking more of this medication than prescribed or taking it more frequently can lead to decreased effectiveness, a phenomenon known as tolerance. If you find that this medication is no longer working as well as it should, consult your doctor. Do not exceed the recommended dosage.

If you are pregnant, planning to become pregnant, or breastfeeding, discuss the potential benefits and risks of this medication with your doctor to make an informed decision about its use.

• Phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil, avanafil) - concurrent use can cause profound and prolonged hypotension.

• Riociguat (soluble guanylate cyclase stimulator) - concurrent use can cause severe hypotension.
• Other vasodilators (e.g., hydralazine, minoxidil) - additive hypotensive effects.
• Antihypertensive agents (e.g., beta-blockers, calcium channel blockers, ACE inhibitors, ARBs, diuretics) - additive hypotensive effects.
• Alcohol - can enhance hypotensive effects and cause syncope.

• Tricyclic antidepressants (TCAs) - may cause orthostatic hypotension.
• Phenothiazines - may cause orthostatic hypotension.

• Not available (most significant interactions are major or contraindicated)

• Headache (common side effect, often indicates drug activity)
• Dizziness or lightheadedness (sign of hypotension)
• Flushing
• Nausea
• Weakness
• Blurred vision

Category C. Animal studies have shown adverse effects, but there are no adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus.

It is not known whether nitroglycerin is excreted in human milk. Caution should be exercised when nitroglycerin is administered to a nursing woman. Consider the benefits of breastfeeding, the risk of potential infant drug exposure, and the risk of untreated maternal condition.

Safety and effectiveness in pediatric patients have not been established. Not routinely used in this population for angina.

Elderly patients may be more susceptible to the hypotensive effects of nitroglycerin and may experience more pronounced dizziness or lightheadedness. Start with the lowest effective dose and titrate carefully. Monitor blood pressure closely.

• Patients should be instructed to sit down before taking nitroglycerin to minimize the risk of orthostatic hypotension and syncope.
• A common side effect is headache, which often indicates the drug is working. Patients should be advised not to stop taking it due to headache, but to report severe or persistent headaches.
• Tablets must be kept in their original amber glass bottle, tightly capped, and protected from light, heat, and moisture to maintain potency. Do not store in pill organizers or cotton-filled containers.
• Patients should be educated on the '3 doses in 15 minutes' rule and to call emergency services (911) if chest pain persists after the third dose.
• Tolerance to the effects of nitrates can develop with frequent or continuous use. This is less common with intermittent sublingual use for acute angina but can occur with long-acting nitrates.

• Other short-acting nitrates (e.g., nitroglycerin spray)
• Long-acting nitrates (e.g., isosorbide mononitrate, isosorbide dinitrate) for chronic angina prevention
• Beta-blockers (e.g., metoprolol, carvedilol) for chronic angina prevention
• Calcium channel blockers (e.g., amlodipine, diltiazem) for chronic angina prevention
• Ranolazine (Ranexa) for chronic angina

If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it is a good idea to consult with your pharmacist. If you have any questions or concerns about this medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.