NITRONAL (Intravenous)

Nitroglycerin injection is used to treat high blood pressure during surgery or to manage congestive heart failure in patients who have had a heart attack. It may also be used to lower blood pressure during surgery. Nitroglycerin injection can sometimes be used to treat chest pain in patients who have not responded well to other treatments.

Nitroglycerin is in a group of medicines called nitrates. It helps by relaxing blood vessels, increasing blood and oxygen flow to the heart, and reducing the heart's workload.

This medicine should only be given by or under the direct supervision of your doctor.

It is very important that your doctor check your progress closely while you are receiving this medicine to ensure it is working properly.

Do not take riociguat (Adempas®), sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®) while you are using this medicine. Using these medicines together may cause blurred vision, dizziness, lightheadedness, or fainting. If you are taking these medicines and you experience an angina attack, you must go to the hospital right away.

Dizziness, lightheadedness, or faintness may occur, especially when you get up quickly from a lying or sitting position. Getting up slowly may help.

This medicine may cause headaches. These headaches are a sign that the medicine is working. If you have severe pain, talk with your doctor.

Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain medical tests.

In deciding to use a medicine, you and your doctor will consider the risks of taking the medicine against the benefits it may provide. Here are some things to think about for this medicine:

Allergies

Inform your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also, let your healthcare professional know if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For over-the-counter products, read the label or package ingredients carefully.

Pediatric

There have not been appropriate studies on the effects of nitroglycerin injection in children. Safety and effectiveness have not been established.

Geriatric

Studies so far have not shown any specific problems in older adults that would limit the usefulness of nitroglycerin injection. However, older patients are more likely to have age-related liver, kidney, or heart issues, which may require caution and a dose adjustment for those receiving nitroglycerin injection.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medication during breastfeeding. Weigh the possible benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Some medicines should not be combined at all, while in other cases, two different medicines may be used together even if an interaction could happen. In such cases, your doctor may want to change the dose, or other precautions may be necessary. It is especially important for your healthcare professional to know if you are taking any of the medicines listed below while you are receiving this medicine. The following interactions have been chosen based on their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may choose not to treat you with this medication or adjust some of your other medicines.

• Avanafil
• Riociguat
• Sildenafil
• Tadalafil
• Vardenafil

Using this medicine with any of the following medicines is usually not recommended, but may be necessary in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Alteplase, Recombinant
• Heparin

Using this medicine with any of the following medicines may increase the risk of certain side effects, but using both may be the best treatment for you. If both medicines are prescribed together, your doctor may adjust the dose or frequency for one or both of the medicines.

• Acetylcysteine
• Apomorphine
• Aspirin
• Dihydroergotamine
• Pancuronium

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used around the time of eating food or certain types of food because interactions may occur. Using alcohol or tobacco with some medicines may also cause interactions. The following interactions have been selected based on their potential significance and are not necessarily all-inclusive.

Other Medical Problems

Having other medical issues may affect how you can use this medicine. Make sure to inform your doctor if you have any other medical problems, especially:

• Allergy to corn or corn products or
• Constrictive pericarditis (a heart disease) or
• Pericardial tamponade (a heart disease) or
• Restrictive cardiomyopathy (a heart disease)—Should not be used in patients with these conditions.

• Diabetes or
• Hypertrophic cardiomyopathy (a heart disease) or
• Hypotension (low blood pressure) or
• Hypovolemia (low amount of blood)—Use with caution. May worsen these conditions.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Rare

• Bluish-colored lips, fingernails, or palms
• dark urine
• difficulty with breathing
• dizziness or lightheadedness
• fever
• headache
• pale skin
• rapid heart rate
• sore throat
• unusual bleeding or bruising
• unusual tiredness or weakness

Incidence not known

• Arm, back, or jaw pain
• blurred vision
• chest pain or discomfort
• chest tightness or heaviness
• confusion
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• fainting
• fast or irregular heartbeat
• sweating

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

• Blurred or loss of vision
• bulging soft spot on the head of an infant
• change in consciousness
• change in the ability to see colors, especially blue or yellow
• cold, clammy skin
• convulsions
• disturbed color perception
• double vision
• feeling of constant movement of self or surroundings
• flushed skin
• halos around lights
• headache, severe and throbbing
• increased sweating
• loss of appetite
• loss of consciousness
• nausea or vomiting
• night blindness
• overbright appearance of lights
• paralysis
• sensation of spinning
• slow or irregular heartbeat
• tunnel vision

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Nitro-Bid
• NITRONAL

Available Dosage Forms:

• Solution

Therapeutic Class: Coronary Vasodilator

Chemical Class: Nitrate

A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given through a needle placed in one of your veins.

• How do you take GoNitro to treat an angina attack (chest pain)?
• What is the shelf life of nitroglycerin tablets?