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Overview: Transdermal nitroglycerin is an ointment or a patch that is used on the skin to reduce your risk of having chest pain from heart disease. The most common side effects of transdermal nitroglycerin are headache and feeling dizzy or lightheaded. Serious side effects are less likely but may include low blood pressure, especially when you go from a sitting or lying position to standing. To help prevent this, be careful not to get up too quickly. Transdermal nitroglycerin can also make you feel dizzy. You should not drive or do other activities that require alertness or coordination until you know how transdermal nitroglycerin affects you. Talk to your health care provider about all of your health conditions and any medicines you take before you start using transdermal nitroglycerin. 

Uses

What is transdermal nitroglycerin used for?

Transdermal nitroglycerin is commonly used to prevent chest pain caused by a type of heart disease (coronary artery disease).

Transdermal nitroglycerin may also be used for other conditions as determined by your health care provider.

How does transdermal nitroglycerin work (mechanism of action)?

Transdermal nitroglycerin relaxes the blood vessels and increases oxygen and blood supply to the heart. Chest pain can occur when your heart does not get enough oxygen and blood. 

How is transdermal nitroglycerin supplied (dosage forms)?

Brands and other names

  • Nitro-BID
  • Nitro-Dur

Dosage forms and strengths

  • 0.1 mg/hr transdermal patch
  • 0.2 mg/hr transdermal patch
  • 0.3 mg/hr transdermal patch
  • 0.4 mg/hr transdermal patch
  • 0.6 mg/hr transdermal patch
  • 0.8 mg/hr transdermal patch
  • 2% ointment

How should I store transdermal nitroglycerin?

Topical Patch. Transdermal nitroglycerin patch should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C), for shorter periods of time, such as when transporting it. Store in a cool, dry place. Do not refrigerate.

Topical Ointment. Transdermal nitroglycerin ointment should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C), for shorter periods of time, such as when transporting it. Keep the tube tightly closed.

Side Effects

What are the most common side effects of transdermal nitroglycerin?

The most common side effects of transdermal nitroglycerin are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Headache
  • Lightheadedness or dizziness 

There may be other side effects of transdermal nitroglycerin that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at https://www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at https://www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of transdermal nitroglycerin?

While less common, the most serious side effects of transdermal nitroglycerin are described below, along with what to do if they happen.

Severe Allergic Reactions. Transdermal nitroglycerin can cause allergic reactions, which can be serious. Stop using transdermal nitroglycerin and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin called hives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Low Blood Pressure Upon Standing (Orthostatic Hypotension). Transdermal nitroglycerin may cause a sudden drop in blood pressure when standing up from a seated or lying position. To help prevent this, be careful not to get up too quickly. If you feel dizzy, sit or lie down right away until the dizziness stops, then take your time getting up again. Tell your health care provider right away if you have any of the following symptoms of orthostatic hypotension.

  • Dizziness, feeling lightheaded, or fainting upon standing
  • Blurred vision
  • Confusion
  • Feeling weak

Warnings & Precautions

Who should not use transdermal nitroglycerin?

Allergies to Ingredients. People who are allergic to any of the following should not use transdermal nitroglycerin.

  • Nitro-BID
  • Nitro-Dur
  • Nitroglycerin
  • Acrylic-based polymer adhesives (topical patch)
  • Any other medicine known as nitrates or nitrites
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific transdermal nitroglycerin products they stock.

Drug Interactions. Transdermal nitroglycerin should not be used while you are using certain other medicines. Before using transdermal nitroglycerin, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section below for more details.

What should I know about transdermal nitroglycerin before using it?

Do not use transdermal nitroglycerin unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share transdermal nitroglycerin with other people, even if they have the same condition as you. It may harm them.

Keep transdermal nitroglycerin including used patches out of the reach of children and pets. Used patches still contain medicine. 

Do not use transdermal nitroglycerin to treat chest pain. Get help right away if you develop chest pain.

Wash your hands and apply transdermal nitroglycerin to clean skin without a lot of hair. Do not apply below the knee or elbow, in skin folds, or on injured skin.

Headaches are a common side effect of transdermal nitroglycerin and are a sign that the medicine is working. These headaches usually decrease over time with continued use. Do not change how often you are using transdermal nitroglycerin unless your health care provider tells you to do so. If you have headaches that are bothersome after using transdermal nitroglycerin, you can ask your health care provider if any over-the-counter pain medicines, such as acetaminophen, are safe for you to use. 

Transdermal nitroglycerin can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how transdermal nitroglycerin affects you.

Slowly rise from a seated or lying position. Hold onto a chair or bed in case you get dizzy.

People who are 65 years of age or older can be at greater risk for some side effects of transdermal nitroglycerin. Talk to your health care provider about your risks if you are in this age group.

What should I tell my health care provider before using transdermal nitroglycerin?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if transdermal nitroglycerin is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

  • Low blood pressure 
  • Heart problems including recent heart attack or heart failure
  • Anemia
  • Increased intracranial pressure such as after head injury or bleeding in the brain

Pregnancy. It is not known if or how transdermal nitroglycerin could affect pregnancy or harm a fetus. Tell your health care provider if you are or plan to become pregnant. Your health care provider will let you know if you should use transdermal nitroglycerin while you are pregnant or trying to get pregnant. 

Breastfeeding. It is not known if transdermal nitroglycerin passes into breast milk and if it can harm your baby. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should use transdermal nitroglycerin while breastfeeding.

Interactions

Does transdermal nitroglycerin interact with foods or drinks?

There are no known interactions between transdermal nitroglycerin and foods or nonalcoholic drinks.

It is unknown if drinking alcohol will affect transdermal nitroglycerin. The risk of dizziness may be increased if you drink alcohol while using transdermal nitroglycerin. It is best to limit the amount of alcohol you drink.

Does transdermal nitroglycerin interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using transdermal nitroglycerin.

  • A type of medicine called a phosphodiesterase-5 (PDE-5) inhibitor, such as avanafil (Stendra), sildenafil (Viagra, Revatio, and others), tadalafil (Cialis and others), or vardenafil (Staxyn), which are used for erectile dysfunction or pulmonary arterial hypertension (PAH)
  • Riociguat (Adempas), which is used to treat high blood pressure in the lungs 
  • A medicine for high blood pressure
  • A beta-blocker, which is a medicine usually used to reduce blood pressure and for certain other heart conditions
  • Aspirin, which is contained in many prescription and OTC products for pain, swelling, and fever
  • Ergotamine (Ergomar) or dihydroergotamine (Migranal or Trudhesa), which are medicines used to treat migraine

This may not be a complete list of medicines that can interact with transdermal nitroglycerin. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much transdermal nitroglycerin?

If you or someone else has used too much nitroglycerin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of transdermal nitroglycerin?

If you miss a dose, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only use the next dose. Do not use double or extra doses.