Congestive Heart Failure
Chest Pain in Women
|What Are Nitrates?
Nitrates are medications used for treating symptoms of angina, specifically they relieve chest pain. The most common form of nitrates is nitroglycerin (also called glyceryl trinitrate or GTN). Others types have more complicated names such as isosorbide dinitrate and isosorbide mononitrate. Some nitrates are taken daily as a pill or worn as a skin patch slowly releasing the drug into the bloodstream. These help prevent chest pain in people who would otherwise suffer regularly. Other nitrates are fast acting and are only taken when pain occurs. These can be taken as a pill or oral spray. It must be noted that while nitrates help treat the symptoms of angina, they do not cure the underlying causes of angina.
What Other Conditions Do They Treat?
Nitrates are also used for treating symptoms of heart failure.
When Do I Take Them?
Nitroglycerin is not expensive and it is not habit forming. For this reason patients can take it several times a day without any harm. Slow release or extended-release capsules are usually taken in pill form 3 to 4 times a day. They prevent pain in people who experience angina attacks more frequently. They also come as a patch which is worn for 12 to 18 hour periods. As long-acting formulas are released slowly into the bloodstream they have a longer lasting effect than short acting nitrates.
Nitroglycerin may also be taken short term on a needs-only basis when chest pain occurs. In such instances it works best if it is taken at the first sign of discomfort. Alternatively, if you learn to recognize what triggers an attack, you can still perform the task but head off pain by taking a pill 5-10 minutes before doing it. Many people experience pain predictably, in other words they can predict what will trigger an attack, be that walking up a stairs, sexual intercourse or presenting at a meeting in work (stress). Being able to head off an angina attack can limit not only immediate pain but also long-term damage to the heart and the arteries.
How Do Nitrates Work?
Reduced blood flow to the heart muscle due to blockages in the arteries supplying it (caused by coronary heart disease) is the main cause of angina chest pain. Pain is the brain's way of telling the body to stop doing the activity that is increasing the body's need for extra blood and oxygen. Nitrates belong to a group of medicines called vasodilators. This means they expand the blood vessels to increase the amount of blood which can flow through at times of high demand (exertion, stress and so on). Once inside the body nitrates convert to nitric oxide which causes the dilation.
How Are They Taken?
||Why It Is Used
||What You Should Know
|Short acting pills
|For quick relief of chest pain.
||Pills should be stored in a cool dry place, usually only have a 8-week shelf life.
Spray is more expensive than pills but has a longer shelf life.
|Long acting pills
||Mainly for prevention
||Need to stop taking the pills for a certain amount of hours every day.
Mainly for prevention
|Patch can cause a skin rash.
Short Acting Pills
These pills are fast acting and work in 2 minutes or less. The effects should last up to 30 minutes. Place the pill under your tongue and let it dissolve. Try not to chew it as this makes it less effective.
The drugs work better if the mouth is moist rather than dry.
Keep your pills with you at all times.
If 3 tablets taken 5 minutes apart do not relieve chest pain, go immediately to emergency unless a different plan has been discussed with your doctor.
Long Acting Pills
The usual dose is a pill taken 2 to 3 times a day, usually 1-2 hours after a meal.
To be effective, capsules should be swallowed whole and not chewed.
Sit down and remove the cap of the spray without shaking the container.
If you are using the container for the first time hold the container upright so that it is pointed away from yourself. Press the button 10 times to prime the container. If it is not the first time, but you have not used it within the past 6 weeks or longer, press the button once to prime it.
Open your mouth and hold the container as closely as possible.
Spray once into your mouth, do not inhale the spray.
Close your mouth and avoid rinsing for 5 to 10 minutes to allow the medication to take effect.
Check the level of liquid in your container from time to time to ensure you do not run out.
Patches are applied once a day to the chest. Avoid using creams or lotions in the area or this will make it difficult for the patch to stick.
Most people remove the patch at night time to prevent the body from becoming immune to the medicine.
When applying the patch, stick it to a different area on the chest to avoid sensitivity. Wait a few days before applying it to the same area.
Do not suddenly stop using patches as this can cause angina to become worse. Treatment should be reduced gradually under the guidance of your physician.
Ointments are used for long-term prevention of angina. A dosage of ointment is spread on specially provided application paper which is then rubbed to the chest area every 4 to 6 hours. It is absorbed through the skin and into the blood stream. The paper is used for spreading the ointment to prevent the medicine being absorbed by the hands.
What Does 'Nitrate Tolerance' Mean?
If a patient continually takes nitrates over a period of 24-48 hours, their body becomes immune to the dosage and the drug is no longer effective. This is a common problem with long-acting nitrates which is why patients are recommended to take breaks. For example pills are only generally taken during the day and patches are not worn while sleeping. Nitrate tolerance is not usually a problem for those taking short-acting pills or sprays because they are not consistently exposed to the drug.
What Are The Side Effects?
Nitroglycerin can cause some side effects, the least worrisome being:
2. Dizziness or weakness.
3. Headaches, but this is usually a sign the medication is working.
Other side effects are more serious. Call your doctor if you experience:
1. Dry mouth.
2. Chest pain.
4. Rash, blistering, or peeling of the skin.
5. Hives or itching skin.
6. Difficulties swallowing or breathing.
7. Vomiting or nausea.
9. Blurred vision.
10. Pale skin.
What Special Precautions Should I Follow?
1. Tell your doctor if you are taking any herbal supplements, pills or other medications, including beta blockers, calcium blockers, aspirin therapy, antiplatelets, anticoagulants, ACE inhibitors or diuretics.
2. Tell your doctor if you recently had a heart attack or anemia (low red blood cell count).
3. Viagra should never be taken with nitrates.
4. Tell your doctor if you are pregnant or planning on becoming pregnant.
5. Ask your doctor about how much alcohol you can safely take while on nitrates.
6. If you are having dental work, tell your dentist you are on nitrates.
Nitrate Medication List: Common U.S. Brand Names
Nitro-BID (and Nitro-BID ointment)
Nitrol ointment (APPLI-KIT)