NITRATES

Brand & Generic Names

Apo-ISDN	Nitro-Dur II
Cardilate	Nitrogard-SR
Cedocard-SR	NITROGLYCERIN (GLYCERYL
Coradur	TRINITRATE)
Coronex	Nitroglyn
Deponit	Nitrol
Dilatrate-SR	Nitrolin
Duotrate	Nitrolingual
ERYTHRITYL TETRANITRATE	Nitronet
Glyceryl Trinitrate	Nitrong
ISMO	Nitrong SR
Iso-Bid	Nitrospan
Isonate	Nitrostat
Isorbid	Novosorbide
Isordil	NTS
ISOSORBIDE DINITRATE	PENTAERYTHRITOL TETRANITRATE
Isotrate	Pentritol
Klavikordal	Pentylan
Naptrate	Peritrate
Niong	Peritrate Forte
Nitro-Bid	Peritrate SA
Nitrocap	P.E.T.N.
Nitrocap T.D.	Sorbitrate
Nitrocine	Sorbitrate SA
Nitrodisc	Transderm-Nitro
Nitro-Dur	Tridil

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes
• Drug class: Antianginal (nitrate)

Uses

• Reduces frequency and severity of angina attacks.
• Treats congestive heart failure.

Dosage & Usage Information

How to take:
Extended-release tablets or capsules-- Swallow each dose whole with liquid.
Chewable tablet--Chew tablet at earliest sign of angina, and hold in mouth for 2 minutes.
Regular tablet or capsule--Swallow whole with liquid. Don't crush, chew or open.
Buccal tablets (Nitrogard)--Allow to dissolve in side of mouth.
Translingual spray (nitrolingual)--Spray under tongue according to instructions enclosed with prescription.
Ointment--Apply as directed.
Patches--Apply to skin according to package instructions.
Sublingual tablets--Place under tongue every 3 to 5 minutes at earliest sign of angina. If you don't have complete relief with 3 or 4 tablets, call doctor.

When to take:
Swallowed tablets--Take at the same times each day, 1 or 2 hours after meals.
Sublingual tablets or spray--At onset of angina.
Ointment--Follow prescription directions.
Patches--According to physician's instructions.

If you forget a dose:
Take as soon as you remember up to 2 hours late. If more than 2 hours, wait for next scheduled dose (don't double this dose).

What drug does:
Relaxes blood vessels, increasing blood flow to heart muscle.

Time lapse before drug works:
Sublingual tablets and spray--1 to 3 minutes.
Other forms--15 to 30 minutes. Will not stop an attack, but may prevent attacks.

Don't take with:
Any other medicine without consulting your doctor or pharmacist.

Overdose

SYMPTOMS:
Dizziness; blue fingernails and lips; feeling of pressure in head, fever, fainting; shortness of breath; weak, fast heartbeat; convulsions.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

In case of overdose, see Overdose section.

Common:

Headache, flushed face and neck, dry mouth, nausea, vomiting.

Infrequent:

• Fainting, rapid heartbeat.
• Restlessness, blurred vision, dizziness.

Rare:

• Rash.
• Severe irritation, peeling.

Warnings & Precautions

Don't take if:
You are allergic to nitrates, including nitroglycerin.

Before you start, consult your doctor:

• If you are taking non-prescription drugs.
• If you plan to become pregnant within medication period.
• If you have glaucoma.
• If you have reacted badly to any vasodilator drug.
• If you drink alcoholic beverages or smoke marijuana.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons.

Pregnancy:
Studies inconclusive on harm to unborn child. Decide with you doctor whether drug benefits justify risk to unborn child.

Breast-feeding:
No problems expected. Consult your doctor.

Infants & children:
Not recommended.

Prolonged use:

• Drug may become less effective and require higher doses.
• Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check blood pressure, heart rate.

Skin & sunlight:
No problems expected.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes.

Discontinuing:
Except for sublingual tablets, don't discontinue without doctor's advice until you complete prescribed dose, even though symptoms diminish or disappear.

Others:

• If discomfort is not caused by angina, nitrate medication will not bring relief. Call doctor if discomfort persists.
• Periodic urine and laboratory blood studies of white cell counts recommended if you take nitrates.
• Keep sublingual tablets in original container. Always carry them with you, but keep from body heat if possible.
• Sublingual tablets produce a burning, stinging sensation when placed under the tongue. Replace supply if no burning or stinging is noted.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
Anticholinergics*	Increased internal eye pressure.
Antidepressants,	Excessive blood
tricyclic (TCA)*	pressure drop.
Antihypertensives*	Excessive blood pressure drop.
Beta-adrenergic	Excessive blood
blockers*	pressure drop.
Calcium channel	Decreased blood
blockers*	pressure.
Carteolol	Possible excessive blood pressure
	drop.
Cholinergics*	Decreased cholinergic effect.
Ephedrine	Decreased nitrate effect.
Guanfacine	Increased effects of both drugs.
Lisinopril	Possible excessive blood pressure
	drop.
Narcotics*	Excessive blood pressure drop.
Nicardipine	Reduced angina attacks.
Nimodipine	Reduced angina attacks.
Phenothiazines*	May decrease blood pressure.
Sotalol	Possible excessive blood pressure
	drop.
Sympathomimetics*	Possible reduced effects of both
	medicines.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Excessive blood pressure drop.
Beverages:	None expected.
Cocaine:	Reduced effectiveness of nitrates.
Foods:	None expected.
Marijuana:	Decreased nitrate effect.
Tobacco:	Decreased nitrate effect.