Why is this medication prescribed?
Nitroglycerin ointment (Nitro-Bid) is used to prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Nitroglycerin ointment can only be used to prevent attacks of angina; it cannot be used to treat an attack of angina once it has begun. Nitroglycerin ointment (Rectiv) is used in adults to treat pain from anal fissures (a split or tear in the tissue near the rectal area). Nitroglycerin is in a class of medications called vasodilators. Nitroglycerin ointment prevents angina by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen. Nitroglycerin ointment treats anal fissure pain by relaxing the blood vessels, which reduces the pressure in the anal tissues.
How should this medicine be used?
Topical nitroglycerin comes as an ointment to apply to the skin. When used to prevent angina, it is usually applied twice a day, once right after waking in the morning, and again 6 hours later. When used to treat anal fissure pain, it is usually applied every 12 hours for up to 3 weeks. If you still have anal fissure pain after using the ointment for 3 weeks, call your doctor. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nitroglycerin ointment exactly as directed. Do not apply more or less of it or apply it more often than prescribed by your doctor.
If you are using nitroglycerin ointment to prevent angina, your doctor will probably start you on a lower dose of nitroglycerin ointment and may gradually increase your dose as needed to control your angina. Nitroglycerin ointment may not work as well after it has been used for some time, especially at higher doses. To help prevent this, your doctor will schedule your doses so that there is a period of time when you are not exposed to nitroglycerin every day. If your angina attacks happen more often, last longer, or become more severe at any time during your treatment, call your doctor.
Nitroglycerin ointment helps to prevent angina attacks but does not cure coronary artery disease. Continue to use nitroglycerin ointment even if you feel well. Do not stop using nitroglycerin ointment without talking to your doctor.
If you are using nitroglycerin ointment to prevent angina, follow your doctor's directions and the guidelines in this paragraph to apply the medication. Nitroglycerin ointment comes with a paper applicator with a ruled line for measuring the dose (in inches). Place the paper on a flat surface and squeeze the ointment onto the paper, carefully measuring the amount specified on your prescription label. If your ointment comes in foil packets, you should know that each packet contains 1 inch of ointment and is to be used for a single dose only. Place the paper on your skin with the ointment side down, and use the paper to lightly spread the ointment to cover an area of skin at least as large as the applicator. Do not rub the ointment into the skin. Tape the applicator in place and cover it with a piece of plastic kitchen wrap to prevent the ointment from staining your clothing. If your ointment comes in a tube, replace the cap and screw it on tightly. If your ointment came in a small foil packet, dispose of the packet. Try not to get the ointment on your fingers. Wash your hands after applying the ointment.
If you are using nitroglycerin ointment to treat anal fissure pain, follow your doctor's directions and the guidelines in this paragraph to apply the medication. Cover your finger with plastic wrap, a disposable surgical glove, or a finger cot. Lay the covered finger alongside the 1 inch dosing line on the side of the nitroglycerin ointment box so that the tip of the finger is at one end of the dosing line. Starting at the finger tip, squeeze the ointment onto your finger for the same length as marked on the box by the 1-inch dosing line. Gently insert the finger with the ointment into the anal canal, up to the first finger joint. Smear the ointment around the inside of the anal canal. If this is too painful, then apply the ointment directly to the outside of the anus. Dispose of the finger covering. Wash your hands after applying the ointment.
If you are using nitroglycerin ointment to treat anal fissure pain, ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.
Other uses for this medicine
This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information,
What special precautions should I follow?
Before using nitroglycerin ointment,
- tell your doctor and pharmacist if you are allergic to nitroglycerin ointment, tablets, spray, or patches; isosorbide (Isordil, Monoket, in BiDil, others), any other medications, or any of the ingredients in nitroglycerin ointment. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you are taking riociguat (Adempas) or if you are taking or have recently taken phosphodiesterase (PDE-5) inhibitors such as avanafil (Strendra), sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis), and vardenafil (Levitra, Staxyn). Your doctor may tell you not to use nitroglycerin ointment if you are taking one of these medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: aspirin; beta blockers such as atenolol (Tenormin, Tenoretic), carteolol , labetalol (Trandate), metoprolol (Lopressor, Toprol-XL), nadolol (Corgard, in Corzide), propranolol (Hemangeol, Inderal, Innopran), sotalol (Betapace, Sorine, Sotylize), and timolol; calcium channel blockers such as amlodipine (Norvasc, in Amturnide, in Tekamlo), diltiazem (Cardizem, Cartia, Dilt-CD, others), felodipine (Plendil), isradipine, nifedipine (Adalat CC, Afeditab, Procardia), and verapamil (Calan, Covera, Verelan); ergot-type medications such as bromocriptine (Cycloset, Parlodel), cabergoline, dihydroergotamine (D.H.E. 45, Migranal), ergoloid mesylates (Hydergine), ergonovine (Ergotrate), ergotamine (in Cafergot, in Migergot), methylergonovine (Methergine), methysergide (Sansert; no longer available in the U.S.), and pergolide (Permax; no longer available in the U.S.); medications for high blood pressure, heart failure, or an irregular heartbeat. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have anemia (a lower than normal number of red blood cells) or have had any condition that increases the pressure in your brain or skull. Your doctor may tell you not to use nitroglycerin ointment.
- tell your doctor if you think you may be dehydrated, if you have recently had a heart attack, and if you have or have ever had low blood pressure, heart failure, hypertrophic cardiomyopathy (thickening of the heart muscle), or migraines or recurrent headaches.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using nitroglycerin ointment, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using nitroglycerin ointment.
- you should know that nitroglycerin ointment may make you dizzy. Do not drive a car or operate machinery until you know how this medication affects you.
- ask your doctor about the safe use of alcoholic beverages while you are using nitroglycerin ointment. Alcohol can make the side effects from nitroglycerin ointment worse.
- you should know that nitroglycerin patches may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position, or at any time, especially if you have been drinking alcoholic beverages. To avoid this problem, get up slowly, resting your feet on the floor for a few minutes before standing up. Take extra precautions to avoid falling during your treatment with nitroglycerin.
- you should know that you may experience headaches every day during your treatment with nitroglycerin ointment. These headaches may be a sign that the medication is working as it should. Do not try to change the times or the way that you apply nitroglycerin ointment in order to avoid headaches because then the medication may not work as well. Your doctor may tell you to take a pain reliever to treat your headaches.
What special dietary instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do if I forget a dose?
Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply a double dose to make up for a missed one.
What side effects can this medication cause?
Nitroglycerin ointment may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- redness or irritation of the skin that was covered by the ointment
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:
- slow heartbeat
- worsening chest pain
- difficulty breathing or swallowing
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).
What should I know about storage and disposal of this medication?
Keep this medication out of reach of children. Close the ointment tube tightly after each use. Store it at room temperature and away from excess heat and moisture (not in the bathroom). If you are using nitroglycerin ointment to treat anal fissure pain, dispose of any leftover ointment 8 weeks after the tube was first opened.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include the following:
- bluish coloring of the skin
- slow or pounding heartbeat
- bloody diarrhea
- shortness of breath
- cold, clammy skin
- loss of ability to move the body
- coma (loss of consciousness for a period of time)
What other information should I know?
Keep all appointments with your doctor.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
- Nitro-Bid® Ointment