Angina and Nitroglycerin: A Practical Guide in Brampton

For people living with angina, a small spray bottle or tablet container can become an important companion. Nitroglycerin, often called “nitro,” is prescribed to relieve chest discomfort caused by angina, and sometimes to prevent it before activities that are known to bring it on. It is one of the oldest heart medications still in use, and it works quickly.

Yet many people who have been prescribed nitroglycerin feel unsure about using it. They worry about side effects, are not sure when to take it, or forget to carry it. Some have a bottle that has been sitting in a drawer for years. Others are not clear on when chest discomfort means they should call 9-1-1 rather than reaching for another dose.

This post is a practical guide to angina and nitroglycerin: what angina is, how nitroglycerin works, how to carry and store it, and how to act safely when symptoms occur. Your own prescriber’s instructions always come first. The pharmacists at Pharmasave BramCentre, 14 - 7910 Hurontario Street in Brampton are happy to go through them with you.

What angina feels like

Angina is chest discomfort that happens when the heart muscle is not getting enough oxygen-rich blood, usually because coronary arteries are narrowed by plaque. People describe it in many ways: pressure, tightness, squeezing, heaviness, burning or aching. It may spread to the arms, shoulders, neck, jaw or back. Some people, especially women, older adults and people with diabetes, feel mainly breathlessness, fatigue or indigestion-like discomfort.

Stable angina usually follows a predictable pattern. It comes on with physical effort, cold weather, a heavy meal or emotional stress, and eases within a few minutes of rest or nitroglycerin.

Unstable angina is different and more dangerous. It may be new, more frequent, more severe, last longer, or occur at rest. Unstable angina can be a warning sign of a heart attack and requires urgent medical attention.

How nitroglycerin works

Nitroglycerin relaxes and widens blood vessels. This reduces the amount of work the heart has to do and can improve blood flow to the heart muscle. The result, for many people, is relief of angina within a few minutes.

Short-acting nitroglycerin comes most often as a spray used under the tongue, or as tablets that dissolve under the tongue. There are also longer-acting nitrate forms, such as patches or tablets, used to prevent angina; these work differently and are not used for sudden symptoms. Ask your pharmacist which type you have and how it should be used.

If you have both a short-acting form for sudden symptoms and a long-acting form for prevention, keep them clearly separate and know which is which. Mixing up a daily patch routine with an as-needed spray is an easy mistake to make, especially when new prescriptions arrive after a hospital stay.

Using nitroglycerin as directed

Your prescriber will give you specific instructions, and your pharmacist will review them when you pick up your prescription. In general, people are told to:

• Sit down before using it, because nitroglycerin can cause light-headedness or a drop in blood pressure.
• Use it as directed under the tongue; do not swallow tablets or inhale the spray.
• Follow the timing and maximum doses specified by your prescriber.
• Call 9-1-1 if symptoms are not relieved according to the plan you have been given.

Many Canadian action plans tell people to call 9-1-1 if chest discomfort is not improving or is getting worse a few minutes after the first dose. Do not wait to see if additional doses will help before calling. Ask your prescriber or pharmacist to confirm the exact plan for you, and write it down.

Common side effects

Nitroglycerin’s effects on blood vessels can cause:

• Headache, often throbbing, which is common and usually short-lived
• Flushing or warmth in the face
• Light-headedness or dizziness, especially when standing
• A drop in blood pressure

Sitting down when you use it, and rising slowly afterward, helps reduce the risk of falling. If side effects are troublesome, tell your pharmacist or prescriber, but do not avoid using nitroglycerin when you need it because of a headache.

A dangerous combination to avoid

Certain medications must not be combined with nitroglycerin or other nitrates because together they can cause a severe, potentially life-threatening drop in blood pressure. The best-known examples are medications used for erectile dysfunction, such as sildenafil, tadalafil and vardenafil, which are also used for some other conditions.

If you have been prescribed nitroglycerin, make sure every prescriber and pharmacist knows. If you take, or are considering, one of these other medications, discuss it openly with your doctor and pharmacist. This is not a conversation to avoid out of embarrassment; it is a genuine safety issue. Paramedics and emergency staff will also need to know if you have taken one of these medications recently.

Carrying it with you, every day

Nitroglycerin only helps if it is within reach when symptoms start. Practical tips:

1. Keep one supply with you at all times: in a pocket, purse or bag you take everywhere.
2. Consider a second supply at home or at work if your prescriber agrees, so you are never far from one.
3. Make sure family members, coworkers or close friends know where you keep it and what it is for.
4. Do not leave it in a hot car in summer or a freezing car in winter.

If you commute along the 407 or 410 or work in a warehouse, office or worksite in Brampton, think about where your nitroglycerin will be during the day.

Storage and expiry dates

Nitroglycerin can lose potency if stored poorly or kept past its expiry date. Tablet forms, in particular, are sensitive to heat, light and moisture, and may have special storage requirements once opened. Sprays tend to be more stable but still have expiry dates.

• Keep it in its original container.
• Store it away from heat, moisture and direct sunlight.
• Check the expiry date regularly, and replace it before it expires.
• Ask the pharmacist how long your particular product stays effective after opening.

When you refill other heart medications through the prescription refill service, ask the pharmacy to check whether your nitroglycerin needs replacing as well.

Using it before activity

Some people are advised to use nitroglycerin a few minutes before activities that reliably bring on angina, such as climbing a hill, walking in cold weather or exertion like shovelling. If your prescriber has recommended this, follow their instructions carefully. If you find you need nitroglycerin more often than before, or for less effort than before, contact your healthcare provider promptly; that change can signal worsening heart disease.

Your broader angina treatment

Nitroglycerin relieves symptoms, but it is usually one part of a broader treatment plan. People with angina may also be prescribed medications to prevent angina episodes, protect against heart attack, control blood pressure and lower cholesterol, along with antiplatelet medications. Lifestyle changes, such as stopping smoking, staying active within safe limits and eating heart-healthy foods, also play a role.

A medication review at Pharmasave BramCentre can help you understand how all your heart medications work together. If you smoke and want to quit, ask about smoking cessation support.

Telling your household what to do

Make sure the people around you know:

• What your angina usually looks like
• Where your nitroglycerin is kept
• When to call 9-1-1
• That they should call 9-1-1 and not drive you to hospital

Writing your angina action plan on a card and keeping it with your nitroglycerin can help you and others act quickly.

In multigenerational homes, it is worth thinking about who is most often with you during the day. If you spend weekday afternoons caring for grandchildren while their parents are at work, an older child can be taught, in simple words, that “if Nana says her chest hurts and she sits down with her spray, call 9-1-1.” If a relative who speaks a different language at home is often with you, make sure the plan is explained to them in that language too.

It is also helpful for at least one family member to come with you to the pharmacy once, so they can hear how the spray is used and ask their own questions. Should a moment come when you are too unwell to explain, the people around you will already know what to do, where to find your medication list, and what to tell the paramedics about what you have taken.

Check your nitro at Pharmasave BramCentre

If you are not sure whether your nitroglycerin is still in date, how to use the spray correctly, or what your action plan should be, come in and ask. A quick check now can make a big difference later.

Pharmasave BramCentre is located at 14 - 7910 Hurontario Street, Brampton, ON L6Y 0P6. Call (905) 497-5177 to speak with a pharmacist, use the contact page for other options, or reserve time on the booking page.

This article is general information about angina and nitroglycerin. Follow your prescriber’s action plan, and call 9-1-1 for chest pain that does not settle as expected.