Nitroglycerin for Chest Pain
Chest pain, medically known as angina, can sometimes be a symptom of heart disease. Angina is common in people with heart failure (HF). The following will help break down what to expect when starting nitroglycerin for the treatment of angina.
What is angina?
Angina occurs when the heart doesn’t get enough oxygen because the arteries are narrowed or blocked. People may experience angina manifesting as discomfort in the chest, such as squeezing, pressure, and sometimes pain. The discomfort can occur during exercise or exerting oneself, and usually lasts 5 minutes or less in duration. Angina symptoms usually resolve upon rest.1
Nitroglycerin is a common medication used to help relieve symptoms of angina. It has been around for over a century - in fact, its first documented use was in 1879. Nitroglycerin works by dilating the arteries, therefore allowing more blood to reach the heart.
Types of nitroglycerin
In some countries, you don’t need a prescription for nitroglycerin. However, I typically recommend people see a physician for a prescription. This is because nitroglycerin can have deadly drug interactions if not taken correctly.
Nitroglycerin comes in many forms and brands. For example, it is supplied as a sublingual (under the tongue) formulation, a patch, or a spray. Nitroglycerin may be used to relieve symptoms of angina or to help prevent future symptoms.
Sublingual nitroglycerin is usually prescribed to treat acute (short) episodes of angina. It can also be used to help prevent symptoms; for example, if someone knows that cleaning their home results in angina symptoms, they can take a dose in anticipation of this activity.
The tablets come in either 0.3 mg or 0.4 mg. The sublingual formulation takes 2-5 minutes to work. The effect usually lasts 15-30 minutes.3 It is often recommended to take one dose every 5 minutes if needed, up to a maximum of three doses. If no relief then, an ambulance should be called. However, this general recommendation should be individualized for each person, so ask your doctor if this is the right approach for you.4
It is very important to store the sublingual tablets somewhere that doesn’t affect their potency. The recommended storage is at room temperature in a tightly capped, dark bottle. Keep the nitroglycerin away from light and heat.5 When going out, keep a small supply of the tablets with you.
The spray delivers 0.4 mg nitroglycerin. It may be sprayed onto or underneath the tongue. Depending on your doctor’s recommendation, you may use 1 or 2 sprays at the start of chest pain.3 Only 3 sprays over a 15 minute period can be used before it is suggested to call emergency services. Make sure to follow the manufacturer’s instructions for priming the spray.
Nitro patches deliver a steady concentration of nitroglycerin to the bloodstream through the skin. One patch is worn for 12 hours a day, and the patch is removed for the remaining 12 hours. This is done to reduce the potential risk of nitrate tolerance, a phenomenon where people need higher and higher doses in order to show a response.7
Despite the formulation of nitroglycerin used, there are side effects that can occur with nitroglycerin use. The most common side effects are headache, low blood pressure, and flushing.8
Starting a new medication can be a stressful experience. By equipping yourself with knowledge and a support system, you will have a better understanding of what to expect during treatment.
What type of heart failure have you been diagnosed with?