Nitro-Time

Nitroglycerin Extended-Release Capsules are indicated for the prevention of angina pectoris due to coronary artery disease. The onset of action of oral nitroglycerin is not sufficiently rapid for this product to be useful in aborting an acute anginal episode.

Allergic reactions to organic nitrates are extremely rare, but they do occur. Nitroglycerin is contraindicated in patients who are allergic to it. Do not use nitroglycerin extended-release capsules in patients who are taking phosphodiesterase inhibitors (such as sildenafil, tadalafil, or vardenafil) for erectile dysfunction or pulmonary arterial hypertension.Concomitant use can cause severe drops in blood pressure. Do not use nitroglycerin extended-release capsules in patients who are taking soluble guanylate cyclase stimulators (such as riociguat).

Concomitant use can cause hypotension.

Amplification of the vasodilatory effects of nitroglycerin by phosphodiesterase inhibitors can result in severe hypotension. The time course and dose dependence of this interaction have not been studied. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion. The benefits of oral nitroglycerin in patients with acute myocardial infarction or congestive heart failure have not been established.

If one elects to use nitroglycerin in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of hypotension and tachycardia. Because the effects at capsules are so difficult to terminate rapidly, that are not recommended in these settings. PRECAUTIONS: General: Severe hypotension, particularly with upright posture, may occur with even small doses of nitroglycerin. This drug should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive.