Annually, in the US around 10 million individuals reportedly experience angina, with the case load increasing by 500,000 every year. Various medications are prescribed to treat the condition and to handle the pain associated with the condition. Nitroglycerin is recommended to prevent the pain that is attributed to coronary heart diseases and is used extensively to also help mitigate the pain during episodes of angina. Similar to all prescription and over the counter medications, the drug has its share of undesirable adverse effects. Here is an in-depth look at the side effects of nitroglycerin and measures to help tone down the undesirable effects.

Overview of nitrates and side effects of nitroglycerin

Belonging to the class of medications known as nitrates, the drug works by bringing about a relaxation in the blood vessels and also increasing the amount of oxygen and blood supplied to the heart. Through this, the drug considerably reduces the burden on the heart, thereby helping mitigate or prevent incidents of angina. The medication is typically taken for longer durations, alongside suitable lifestyle modifications. It is essential to know more about the medication to understand the side effects of nitroglycerin. The prescription only medication is available as a spray, as tablets, capsules in extended-release formulations and in packets.

Angina or chest pain is attributed to the condition when there is heavy workload on the heart or when there is any kind of restriction in the flow of blood to the muscles in the heart. This causes the muscles to overwork, resulting in the sharp pain, commonly known as angina. The decreased blood flow or restricted flow is attributed to the build up of plaque in the blood vessels, thereby narrowing the vessels that move blood to the muscles in the heart. Before we look at the side effects of nitroglycerin, here is additional information on the mechanism of action of the drug. The medication works by opening up the blood vessels, thereby relaxing the work load of the heart muscles. By enabling the desired volume of blood and oxygen supply to the heart, the medication helps prevent angina. By virtue of the mechanism of action, the medication is also recommended for treating certain chronic conditions of anal fissures.

The mechanism of action of the medication begins within a very short time – within a few minutes of taking the medication, results are experienced. However, optimal results are felt by the patient 5 minutes after taking the medication. As a result of the fast results from the medication, it is used for mitigating pain in patients in the midst of angina. Nitroglycerin is broken down into nitric oxide, which in turn is responsible for relaxation of the smooth muscles of the blood vessels. Known as vasodilation, this opens up the veins and arteries, thereby permitting enhanced blood flow. Before we look at the side effects of nitroglycerin, it is not out of place to mention the benefits of the medication in treating anal fissures.

Used topically to treat anal fissures, the medication works by relaxing the sphincter muscles, thereby bringing down the pressure around the anus. As a consequence, blood flow to the anus and the area around the anus is enhanced, which in turn brings about faster healing of the fissure. The different forms of the medication are intended to be used in different methods for optimal results. For instance, the aerosol form, the tablets and the packet form of nitroglycerin is typically dissolved beneath the tongue. The topical application formulations are applied on the skin, and this includes the medication that is available as a patch. To prevent side effects of nitroglycerin it is important to use the formulation intended for anal fissures, only on the rectum and not for any other purpose.

Tips to avoid side effects of nitroglycerin

The possibility of side effects of nitroglycerin from improper use cannot be ruled out. It is therefore important to use the medication as recommended for specific conditions. For instance, for individuals with angina, nitroglycerin is typically taken a few minutes before commencing any physical activity that is known to cause angina. The aerosol spray is meant to be used only as a spray beneath the tongue and the contents are not to be inhaled. Individuals who use the sublingual packet, are to place the it beneath the tongue, on experiencing the first symptoms of angina.

All forms of the medication are fast acting, and are prescribed as per various conditions.

The tablet is also placed under the tongue and the dissolved ingredients are quickly absorbed by the tissues in the mouth, delivering the desired outcomes. Individuals who have taken the medication beneath the tongue are to avoid spitting or rinsing during the period immediately after taking the medication. The ideal way of taking the medication is to leave a gap of 5 minutes between doses, if required, in the event the individual does not experience relief from the chest pain. The maximum number of such consecutive doses with intervals should be three, following which the individual should seek medical intervention to deal with the pain.

Apart from the above formulations and presentations, nitroglycerin is also available in other forms. However, some forms are not fast acting in nature and are not suitable for use when the patient is in the middle of an attack or experiencing pain. Patches are intended to be used on any part of the body, except the limbs beneath elbows and knees. Ideally, patches are to be placed on the chest, on cleaned areas without hair, for maximum results. Patches are meant to be left on the skin for during the day, and removed during the night. Individuals using nitroglycerin for treating anal fissures are to apply the ointment once every 12 hours for a period of three weeks.

Commonly reported side effects of nitroglycerin

With all the background information behind, it is time to look at the commonly reported side effects of nitroglycerin. For instance, headaches are frequently reported by individuals using the medication. Overall fatigue or weakness that is not attributed to any specific condition is also one of the reported undesirable effects of the drug. Patients are known to experience a sudden change in heart beat rate and pattern when on the drug. Other adverse effects include nausea that may or may not be accompanied by vomiting. A small section of individuals are also known to feel dizzy or faint, while some experience excessive sweating for no apparent reason or change in climate.

Other side effects of nitroglycerin include bloating in various parts of the body – the face, and limbs. Patients reportedly experience some kind of abnormal spinning sensation, while many experience a sensation of pricking with pins and needles. Breathing is likely to be heavy and labored, while there could be a discernible change of color in the skin on the face or neck. Individuals may appear flushed in the face with a reddish appearance in the skin. An abnormal gain in weight is also a possibility that is associated with the condition.

Tips to avoid commonly reported side effects of nitroglycerin

Some of the above reported side effects of nitroglycerin can be prevented or reduced through simple measures. For instance, it is necessary for patients to remain in a resting position for a short period after taking the drug. Any sudden movement or action in rising can result in dizziness or fainting. This is mainly because the of the reduction in blood pressure levels when nitroglycerin is used, and sudden movements can aggravate the condition, resulting in adverse effects.

Similarly, individuals with pre-existing conditions such as pressure in the brain or patients diagnosed with anemia are advised to avoid the medication. Additionally, patients who have experienced heart attacks on the right side of the heart are also strictly advised to avoid the medication. Allergic reaction to nitroglycerin is also another reason for looking at alternate medications. The nature of the medication makes it a long-term treatment option, and this could pose a serious risk to individuals with a history of allergy to the medication. Similarly, individuals who are at risk of experiencing any side effects of nitroglycerin due to specific pre-existing conditions are also to avoid the medication.

Side effects of nitroglycerin : drug interactions with other medications

The nitrate is also known to have drug interactions with other medications. For instance, the mechanism of action of nitroglycerin is similar to that of PDE-5 inhibitors. Prescribed for helping patients with erectile dysfunction, the inhibitors work in a manner similar to the drug and this could result in a considerable increase in blood pressure levels. It is therefore necessary to avoid taking both medications together, with a clear gap between the two as determined by the treating specialist. Since most of the nitroglycerin formulations are fast acting, sufficient gap between both medications will serve the purpose. However, in the event of nitroglycerin formulations that have a long half-life or are long acting in nature, individuals are advised to fully avoid PDE-5 inhibitors.

Dealing with side effects of nitroglycerin caused by overdose

Overdose is a possibility and the ensuing side effects of nitroglycerin from overdoses can be mitigated to a certain extent. The most commonly reported conditions that trigger overdose is either consumption of a combination of nitroglycerin with PDE-5 inhibitors, or excessive dosages during angina attack. While there are specific instructions for patients to take nitroglycerin with an interval of 5 minutes between consecutive doses and a limit on the number of such doses, patients are known to ignore these instructions. As a consequence, overdose related outcomes are experienced.

Symptoms that indicate possible overdose include a rapid decrease in blood pressure levels, while some experience an increase in heart beat rate. The patient is likely to experience symptoms that are similar to side effects of nitroglycerin. For instance, individuals may experience headaches, while many may experience the effects of an increase in blood flow to the brain. Resultantly, patients may feel confused, and dizzy for no apparent reason. This could also have an impact on vision, with patients ending up with blurred vision. The overdose related effects of nitroglycerin cannot be revered with drugs, but the effects are mitigated by either elevating the legs of the patient or by administering intravenous fluids.

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