Adult Dosing

Acute angina pectoris

• At the onset of an attack: 1 or 2 sprays onto or under tongue; repeat q3-5 mins
• Max: 3 sprays in a 15-min period
• Do not rinse mouth for 5-10 mins after dose

Prophylaxis of angina pectoris

• 1-2 Sprays 5 to 10 min onto or under tongue before activity that might precipitate an anginal attack
• Do not rinse mouth for 5-10 mins after dose

Pediatric Dosing

• Safety and effectiveness have not been established in pediatric patients

[Outline]

• Adult Dosing
• Pediatric Dosing

• Acute angina pectoris
• Prophylaxis of angina pectoris due to coronary artery disease

• Hypersensitivity to any of the ingredients of the product
• Use of phosphodiesterase inhibitors for erectile dysfunction (Nitrolingual)
• Severe anemia (NitroMist)
• Increased intracranial pressure (NitroMist)
• Methemoglobinemia

• N/A

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

See Supplemental Patient Information

• Use of Nitrolingual spray along with certain drugs (phosphodiesterase inhibitors) taken for erectile dysfunction can result in severe hypotension; treat these patients as nitrate overdose, with elevation of the extremities and with central volume expansion
• Monitor for hemodynamic changes and clinical status if used in acute myocardial infarction
• Use lowest effective dose for relief of acute anginal attack, as excessive use develops tolerance
• Even small dose can cause severe hypotension, particularly in upright posture. Use cautiously in patients who are volume depleted or already hypotensive
• Nitroglycerin-induced hypotension can result in paradoxical bradycardia and increased angina pectoris
• May aggravate angina caused by hypertrophic cardiomyopathy
• May develop tolerance to nitroglycerine and cross-tolerance to other nitrates and nitrites
• Long-term exposure to nitroglycerin demonstrates physical dependence and causes chest pain, acute myocardial infarction, and even sudden death during temporary withdrawal
• May result in severe dose-related headaches
• Anginal attacks, being more easily provoked and rebound in the hemodynamic effects, are usually observed soon after nitrate withdrawal

Cautions: Use cautiously in

• Volume depletion
• Hypotension
• Increased ICP
• Acute MI
• CHF
• Head injury
• Idiopathic hypertropic subaortic stenosis

Supplemental Patient Information

• Avoid shaking the spray before use
• Avoid inhaling the spray

Nitrolingual, Nitromist interacts with :

	Adcirca
	Cialis
	Levitra
	Revatio
	Sildenafil
	Staxyn
	Tadalafil
	Vardenafil
	Viagra

Pregnancy Category:C

Breastfeeding: Have not been studied during breastfeeding; after breastfeeding observe infants for flushing and discomfort. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 10 December 2010). However manufacturer advises caution as many drugs excrete in human milk.

• CV: Hypotension, collapse, peripheral edema, paradoxical bradycardia, reflex tachycardia
• CNS: Severe and consistent headache, dizziness, weakness, postural hypotension, restlessness, asthenia, light-headedness
• NEURO: Paresthesia
• RESP: Dyspnea
• GI: Nausea, vomiting, abdominal pain
• DERM: Perspiration, drug rash, exfoliative dermatitis, flushing
• EENT: Pharyngitis, rhinitis
• HEMA: Methemoglobinemia
• HYPERSENSITIVITY: Anaphylactoid reactions
• MISC: Tolerance/dependence

• Organic nitrate, vasodilator; stimulates the synthesis of cGMP which results in the relaxation of vascular smooth muscle and vasodilatation. Dilatation of the veins decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure
• Primarily metabolized in the liver by nitrate reductase; converted to inorganic nitrate and the active 1,2 and 1,3 dinitroglycerols; CYP450
• Extrahepatic sites of metabolism include RBC and vascular walls
• Renally excreted
• Half life: 3 mins; 40min for metabolites

US Trade Name(s)

• Nitrolingual
• Nitromist

US Availability

nitroglycerin (generic)

• SL SPRAY: 0.4 mg/spray

Nitrolingual

• SL SPRAY: 0.4 mg/spray

Nitromist

• SL Aerosol: 0.4 mg/spray

Canadian Trade Name(s)

• Mylan-Nitro
• Nitrolingual
• Rho-Nitro

Canadian Availability

Mylan-Nitro

• SL SPRAY: 0.4 mg/spray

Nitrolingual

• SL SPRAY: 0.4 mg/spray

Rho-Nitro

• SL SPRAY: 0.4 mg/spray

UK Trade Name(s)

• Coro-Nitro
• Glytrin
• Nitrolingual
• Nitromin

UK Availability

glyceryl trinitrate (generic)

• SL Spray: 0.4 mg/spray

Coro-Nitro

• SL SPRAY: 0.4 mg/spray

Glytrin

• SL Spray: 0.4 mg/spray

Nitrolingual

• SL SPRAY: 0.4 mg/spray

Nitromin

• SL SPRAY: 0.4 mg/spray

Australian Trade Name(s)

• Nitrolingual

Australian Availability

Nitrolingual

• SL SPRAY: 0.4 mg/spray

[Outline]

Cardiovascular

Antianginal Agents

Nitrates

Pricing data from www.DrugStore.com in U.S.A.

• Nitrolingual 0.4 MG/SPRAY SOLN [Bottle] (ARBOR PHARMACEUTICALS)
  4.9 spray = $204
  14.7 spray = $596
• NitroMist 400 MCG/SPRAY AERS [Bottle] (AKRIMAX PHARMACEUTICALS)
  8.5 spray = $220
  25.5 spray = $619.98
• Nitrolingual 0.4 MG/SPRAY SOLN [Bottle] (ARBOR PHARMACEUTICALS)
  12 spray = $301.98
  36 spray = $882.99

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.