Nitrates: Uses, common brands, and safety info

Have you ever heard of the term angina or angina pectoris? This is the medical term for chest pain due to coronary heart disease or cardiovascular disease. As explained by the American Heart Association, chest pain happens when the heart does not get enough blood, usually because of narrowed or blocked arteries (ischemia). 

This chest pain may feel like uncomfortable pressure, fullness, squeezing, or pain in the chest. The pain may also occur in other places like the neck, jaw, shoulder, back, or arm. If you have narrow arteries, enough blood may get to the heart when you are sitting or resting, but when you exert yourself, such as when walking or mowing a lawn, the heart needs more oxygen, and you may feel chest pain. In addition to physical exertion, other chest pain triggers may include stress, hot or cold weather, heavy meals, or smoking.

Chest pain usually feels the same way every time, lasts for several minutes and is relieved by rest and/or medication (nitroglycerin). Nitroglycerin relaxes arteries and blood vessels to help more blood get to the heart. Nitroglycerin and other nitrate medications are available in different formulations to prevent or treat chest pain. Continue reading to learn all about nitrate medications.

Other nitrates

Other medications that contain nitrates that you would not purchase in a pharmacy include:

• Nitropress (sodium nitroprusside): a strong medication given as an intravenous infusion. Nitropress immediately lowers blood pressure in a hypertensive crisis. This medication can be found most commonly in hospitals.

• Amyl nitrite, butyl nitrite: Although illegal and abused, these are referred to as “poppers” and can have dangerous interactions with other medications such as erectile dysfunction medication Viagra. Although these are illegal, and not found in any pharmacy, it is worth mentioning that they contain nitrates.

What are nitrates?

Nitrates are known as vasodilator medications. They widen blood vessels, allowing more blood to get to the heart. Nitrates treat chest pain and symptoms of heart failure. Nitrates are available in various formulations to prevent or treat chest pain.

How do nitrates work?

Nitrates relax and dilate veins and arteries, including coronary arteries. This mechanism of action causes dilation, helps improve blood flow, and helps improve symptoms of chest pain. Nitrates are available in several formulations, as described below. 

What are nitrates used for?

Some nitrates are used to prevent angina pectoris due to heart disease (coronary artery disease). These include short-acting and long-acting nitrates in the form of oral tablets and capsules, as well as transdermal (patches), and topical ointment products that contain nitroglycerin. These products do not work fast enough to stop an acute chest pain episode, so they are used for the prevention of chest pain.

Other nitrates medications are approved by the FDA (U.S. Food and Drug Administration) and are used for the acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease. These include nitroglycerin sublingual tablets, Nitrolingual spray, and Nitromist. They work quickly to stop chest pain, or can be used right before exertion to prevent chest pain.

Rectiv is a nitroglycerin ointment that is applied rectally for the treatment of moderate to severe pain due to anal fissures.

Types of nitrates 

Nitrates can be categorized by how they are used.

Sublingual nitroglycerin

Sublingual drugs are medications that are used under the tongue. Sublingual nitroglycerin is used to treat sudden attacks of chest pain or to prevent chest pain while performing activities that may trigger chest pain, such as exercise. 

The tablet form is the most commonly used sublingual treatment. While the patient is seated, one pill is placed under the tongue and will start working within several minutes. The dose can be repeated up to two times (five minutes apart) if the chest pain does not subside. After 15 minutes, if the pain does not go away, call 911. 

Sublingual nitroglycerin is also available in a spray form, which is less commonly prescribed than the tablet form. Examples of sublingual nitroglycerin include Nitrostat tablets, Nitrolingual spray, and Nitromist spray.

Oral nitrates

Oral nitrates are used to prevent and control angina, but do not treat an acute attack. Oral nitrates include isosorbide dinitrate and isosorbide mononitrate (immediate-release or extended-release). 

Transdermal nitroglycerin

Transdermal nitroglycerin products include patches such as Minitran, Nitro-Dur, and generic nitroglycerin transdermal patches. These patches deliver a constant dose of nitroglycerin. The patch must be removed daily for a “nitrate-free” interval as determined by the prescriber. For example, some people apply the patch in the morning and remove it at bedtime, while others apply a patch at night and remove it in the morning. 

Who can take nitrates?

Can men take nitrates?

Adult men can take nitrates, provided that they do not fall into one of the restricted categories below. Also, adult men cannot take nitrates in combination with erectile dysfunction medications like Viagra or certain other medicines that may have drug interactions with nitrates. 

Can women take nitrates?

Adult women can take nitrates, provided that they do not fall into one of the restricted categories below, and if they do not take any medications that interact with nitrates. If you are pregnant, planning to become pregnant, or breastfeeding, consult your healthcare professional for medical guidance regarding nitrate medications.

Can children take nitrates?

Nitroglycerin has not been studied for safety and efficacy in children. 

Can seniors take nitrates?

The prescribing information for nitrates states that in older adults, dose selection should be cautious, starting lower to account for any possible decrease in liver, kidney, or heart function. Your doctor can determine an appropriate dosage if an adjustment is required.

Are nitrates safe?

Nitrates recalls

There are no recalls at this time.

Nitrates restrictions

Nitrates have several contraindications (situations where they must not be used) in certain people. Do not take nitrates if:

• You are taking a PDE-5 (phosphodiesterase type 5) inhibitor like sildenafil, avanafil, tadalafil, or vardenafil—the combination can cause severely low blood pressure (hypotension) and fainting.  

• You are taking a guanylate cyclase stimulator like riociguat—the combination can cause low blood pressure. 

• You have severe anemia.

• You have increased intracranial pressure.

• You are allergic to nitroglycerin or nitrates.

• You are in acute circulatory failure or shock.

Other precautions:

• Excessive nitrate use may lead to tolerance. Consult your doctor, who will determine proper dosing and scheduling to prevent tolerance.

• Nitrates can worsen chest pain caused by hypertrophic cardiomyopathy (a condition where the heart muscle is abnormally thick).

• Nitrates can cause headaches, especially when you start to take a nitrate medication. Headaches may be severe but usually go away after a while. Consult your healthcare professional for advice on the treatment of headaches if necessary.

• If you are using sublingual nitroglycerin tablets, store them at room temperature in the original glass container and cap tightly after use. Ask your pharmacist about the expiration date and other storage requirements.

• Severe low blood pressure may occur, especially in patients with certain heart conditions, dehydration, or who already have low blood pressure. This can happen even with normal doses. Symptoms like nausea, vomiting, or fainting may occur.

• Low blood pressure is also more likely when going from a sitting or lying to a standing position. Some patients may faint as a result. The risk of occurrence is higher when taking other medications that lower blood pressure or if the patient is dehydrated. 

• Medicines used for erectile dysfunction, such as Viagra, Cialis, Levitra, or Stendra, should never be used in combination with a nitrate medication. The combination can cause a dangerous decrease in blood pressure. 

• Nitrates can interact with other medications as well, such as high blood pressure medications (medications for hypertension), including calcium channel blockers, beta blockers, ACE inhibitors, and others. Nitrates can also interact with certain heart medications, migraine medications, certain antidepressants, and OTC cough and cold medications. 

• Avoid alcohol while taking a nitrate medication, as it can lower your blood pressure.

• Consult your doctor about adequate hydration to prevent dehydration. 

• Tell your doctor about all of the medical conditions you have and all of the medications you take, including prescription, over-the-counter, and vitamins, so he or she can determine if a nitrate is safe for you.

Can you take nitrates while pregnant or breastfeeding?

Consult your doctor if you are pregnant, planning to become pregnant, or breastfeeding. There is very little data on nitrate use in pregnant and breastfeeding women. Your doctor can give you medical advice regarding taking nitrates while pregnant or breastfeeding.

Are nitrates controlled substances?

No, nitrates are not controlled substances. 

Common nitrates side effects

The most common side effects of nitrate medications include:

• Headaches

• Lightheadedness or dizziness (older adults are more susceptible and should be careful in hot weather), which may indicate dehydration

• Flushing

• Increased heart rate (tachycardia)

• Low blood pressure

Other side effects may include weakness, palpitations, nausea, vomiting, sweating, paleness, fainting, restlessness, blurry vision, or skin reactions.

Other side effects may occur. Talk to your healthcare professional about what side effects to expect and how to address them. 

How much do nitrates cost?

The price of your nitrate prescription will depend on the formulation, dose, quantity, and availability in brand or generic form. Ask your doctor if the product he or she would like to prescribe is available in generic. 

You can always use a free SingleCare card to save up to 80% off your nitrate prescription and refills. With our free SingleCare card and coupons, you can pay under $10 for certain forms of nitrates that are available in generic form.