GLYCERYL TRINITRATE WARNINGS
Glyceryl trinitrate should be used with caution in:
- People with kidney disease
- People with liver disease
- People with low blood volume (hypovolaemia)
- People with low blood pressure (hypotension)
- People with a low level of oxygen in the blood
- People with anaemia
- People with low body temperature (hypothermia)
- People with an underactive thyroid gland (hypothyroidism)
- People suffering from malnutrition
- People with a recent heart attack or congestive heart failure
- People taking diuretics (water tablets)
The rectal ointment should be also used in caution in:
- People with haemorrhoids (piles)
It should not be used in:
- Children (under 18 years)
- People allergic to glyceryl trinitrate or any of the other ingredients in the medicine
- People allergic to other nitrates
- People with severe low blood pressure
- People with insufficient blood flow in the brain or increased intracranial (inside brain) pressure (e.g. from brain haemorrhage or head injury)
- People with insufficient heart blood flow due to obstruction with certain heart conditions (e.g. aortic or mitral stenosis, hypertrophic obstructive cardiomyopathy, constrictive pericarditis or pericardial tamponade)
- People with marked anaemia
- People with migraine or recurrent headache
- People with closed-angle glaucoma (a condition where pressure inside the eye rises rapidly causing loss of vision)
- Men taking sildenafil, tadalafil or vardenafil for erectile dysfunction (impotence)
- People taking nitric oxide (NO) donors, such as other long-acting glyceryl trinitrate products, isosorbide dinitrate and amyl or butyl-nitrite.
- People taking other medicines that may cause additive blood pressure lowering effects. These medicines include the following classes of medicines: vasodilators, calcium channel blocking agents, ACE inhibitors, beta-blockers, anti-hypertensive agents, tricyclic antidepressants, phenothiazines and alcohol.
- People taking morphine-like pain killers
Also see list of precautions and interactions
- Store below 25°C in a dry place protected from light. Do not use within 8 weeks of opening the bottle. Close the bottle tightly after use.
- Store below 25°C. Keep away from frost, direct sources of heat and sunlight.
- Store below 25°C. Do not refrigerate.
- Remember to return any unused patches to your pharmacist and dispose of the used ones carefully as they may still contain some active medication.
- Do not store above 25°C.
- Do not freeze.
- Keep the tube tightly closed
GLYCERYL TRINITRATE USES
What is it used for?
- Glyceryl trinitrate is used to treat angina (sudden pains in the chest), heart failure and in heart surgery. It is also used as a rectal ointment to relieve the pain from anal fissures, which are tears in the lining of your anal passage.
- It is a nitrate, sometimes known as a nitrate vasodilator.
- It is used to maintain blood flow to the heart and relieve the symptoms of angina and heart failure. As a rectal ointment, it is used to increase the blood flow in the anus and reduce the anal pressure which helps to reduce the pain.
- In general this drug is used to relax blood vessels and increase the blood flow through the heart. This relieves the symptoms of angina and heart failure as it widens the blood vessels and reduces the amount of work that the heart does in pumping blood around the body.
- Benefits of being on this drug can include immediate relief from the symptoms of angina and lead to an improvement in the frequency and severity of angina. It also relieves the symptoms of heart failure such as breathlessness and improves exercise capacity. The rectal ointment reduces the level of daily pain arising from an anal fissure.
Listed below are the typical uses of glyceryl trinitrate.
- Prevention and treatment of angina pectoris
- Heart failure
- To improve blood flow in heart surgery
- Relief of pain associated with chronic anal fissure (as the rectal ointment)
- Control of blood pressure during operations (IV)
HOW TO USE/TAKE
How often do I take it?
- Glyceryl trinitrate is available as tablets, spray, transdermal patch, skin ointment, rectal ointment and as an injection.
- Glyceryl trinitrate patch is an adhesive patch which is applied to the skin. The patch is suitable for continual or intermittent use and is normally applied to the chest or upper arm. It is applied once daily for 24 hours or for every 12 hours or so with a nitrate free period for some patients, as directed by your doctor. The patches are used for the prevention of anginal symptoms.
- Glyceryl trinitrate can also be given as a tablet or as a spray to be taken sublingually (under the tongue) for the immediate relief of angina symptoms or as an injection. The tablet is placed under the tongue or the spray sprayed under the tongue as shown in the patient information leaflet. Glyceryl trinitrate tablets or spray must not be swallowed. It is normally given as an injection in emergency situations and will be injected into a vein by a doctor or nurse. Glyceryl trinitrate ointment can be applied to the skin every 3- 4 hours as required for the treatment of angina. The dose given with the ointment can be measured and applied using a special paper enclosed in the carton. Details of how do this are shown in the Patient Information Leaflet.
- Glyceryl trinitrate rectal ointment for topical use is used to treat pain associated with anal fissures. The ointment is applied to the rectal area every 12 hours as directed by your doctor.
- Use this medication for duration of prescription in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- This medicine may cause dizziness and blurred vision, which may affect your ability to drive and operate machinery. If you are affected, you should avoid driving or operating machinery until you feel safe to do so. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.
Always complete the full course as prescribed by your doctor
GLYCERYL TRINITRATE SIDE EFFECTS
- Feeling light-headed
- Low blood pressure
- Anal discomfort, itching, soreness (rectal ointment only)
- Rectal bleeding (rectal ointment only)
- Temporary loss of consciousness
- Rapid heart beat
- Application site reactions including itching, swelling, rash, burning (transdermal patch)
- Chest pain
- Slowing of the heart rate
- Stomach pain
- Serious allergic reaction (see below)
- Red blood cell problems with a condition known as methaemoglobinaemia (when red blood cells stop working properly leading to a decrease in blood oxygen content).
If any of these persist or you consider them severe then inform doctor or pharmacist.
Tell your doctor immediately if you develop any of the following symptoms:See serious allergic reaction below
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website
GLYCERYL TRINITRATE PRECAUTIONS
Before taking glyceryl trinitrate, tell your doctor or pharmacist if you are allergic to it; or to other nitrates; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have:
- Low blood pressure
- Blood flow problems in the brain
- Migraine or recurrent headaches
- Heart blood flow problems (due to obstruction)
- An eye condition known as closed-angle glaucoma
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following
- Liver disease
- Kidney disease
- Haemorrhoids (rectal ointment only)
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- Alcohol intake may increase the blood pressure lowering effects of glyceryl trinitrate. You may experience light-headedness and dizziness, particularly on sitting or standing up, after the consumption of alcohol.
The elderly: glyceryl trinitrate can be used in the elderly. Care should be taken as this group of patients are more likely to experience hypotension on changing position. (postural hypotension).
Pregnancy and breastfeeding - please ensure you read the detailed information below
The safety of glyceryl trinitrate has not been established during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
The safety of glyceryl trinitrate has not been established whilst breastfeeding
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
GLYCERYL TRINITRATE INTERACTIONS
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:
- Nitric oxide (NO) donor medicines, such as other long-acting glyceryl trinitrate products, isosorbide dinitrate, amyl nitrite and butyl nitrate used to treat angina and/or heart failure.
- Sildenafil, tadafil and vardenafil used to treat impotence
If you are currently using any of these medications, tell your doctor or pharmacist before starting glyceryl trinitrate ointment.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Non-steroidal anti-inflammatory drugs (some types of pain killer)
- Any medicines taken to lower blood pressure
- Tricyclic antidepressants to treat depression such as imipramine
- Antipsychotics used to treat mental disorders such as chlorpromazine
This information does not contain all possible interactions. Therefore, before using glyceryl trinitrate, tell your doctor or pharmacist of all the products you use.
GLYCERYL TRINITRATE OVERDOSE
Accidental overdose may result in severe low blood pressure (hypotension), reflex rapid heart beat (tachycardia) and temporary loss of consciousness (syncope). Excessive dosage may also give rise to methaemoglobinaemia (damage to red blood cells).
Increased intracranial pressure with associated cerebral symptoms may occur.
A hypotensive headache is a sign of overdosage. High doses of glyceryl trinitrate may cause marked hypotension and collapse, however topical application reduces the likelihood of overdosage and the effect can be quickly terminated by washing the ointment off the skin.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of glyceryl trinitrate or intentional overdose is suspected, contact your local hospital, GP or if in England call 111 or NHS Direct. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
Do not use a double dose to make up for forgotten individual doses. Take the next dose at the usual time.