Nitrates

Examples of Medications

Long-acting: nitroglycerin (Nitro-Dur™, Minitran™), isosorbide mononitrate (Imdur™, ISMN™)
Short-acting: nitroglycerin spray (Nitrolingual Pump™)

Role and Use

Nitrates are medications that dilate bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels, helping to lower bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure and reduce the heart’s workload.

They are mainly used to relieve angina (chest pain caused by reduced oxygen supply to the heart).

Long-acting forms are used for long-term prevention of angina episodes.
Short-acting forms, such as nitroglycerin spray, are used in emergencies to quickly relieve an angina attack.

How to Take Them

A nitroglycerin transdermal patch is applied to the skin in the morning or evening and must be removed after twelve hours to allow a medication-free period, which helps maintain its effectiveness.

Isosorbide mononitrate is usually taken once a day by mouth.

Nitroglycerin spray is used during an acute angina episode, but it can also be taken preventively before physical exertion that usually triggers pain — for example, climbing a hill or stairs. In all cases, it is recommended to sit down before use. Spray under the tongue and, if needed, repeat every five minutes, up to a maximum of three doses.

⚠️ If the pain persists after one or two sprays, it is essential to go to the emergency room immediately.

Possible Side Effects

The most common side effects are headaches — often temporary, especially at the start of treatment — which can usually be relieved with acetaminophen, and dizziness.

Both effects are caused by the rapid dilation of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels triggered by the medication.

Important Warning

Combining nitrates with erectile dysfunction treatments is dangerous.
This combination can cause a marked drop in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure, which may lead to severe fainting or shock.

The contraindication applies to all forms containing phosphodiesterase type 5 inhibitors (PDE5 inhibitors), regardless of the route of administration:

Oral tablets: sildenafil (Viagra™), tadalafil (Cialis™), vardenafil (Levitra™), avanafil (Spedra™)
Topical gel or cream (applied directly to the penis)
Intracavernosal injection (directly into the penile erectile tissue)
Urethral tablet or pellet (inserted into the urethra)

Even when applied locally, these forms are absorbed into the bloodstream and can still cause a dangerous drop in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure when combined with nitrates.

💡 In other words: regardless of the form, this combination must be completely avoided.

If you are taking erectile dysfunction medication, always inform your doctor and pharmacist before being prescribed nitrates.

Conclusion

Nitrate therapy is effective for relieving or preventing angina attacks, provided it is used correctly and safely. Proper medical follow-up and adherence to precautions ensure the best results while minimizing risks.