Nitrolingual pump spray (glyceryl trinitrate)
|Main use||Active ingredient||Manufacturer|
|Angina||Glyceryl trinitrate||Merck Serono|
How does it work?
Nitrolingual pump spray contains the active ingredient glyceryl trinitrate, which is a type of medicine called a nitrate. It is used to help the heart work more easily. Glyceryl trinitrate is also available without a brand name, ie as the generic medicine.
Glyceryl trinitrate works by being converted in the body to a chemical called nitric oxide. This chemical is made naturally by the body and has the effect of making the veins and arteries relax and widen (dilate). When the blood vessels dilate in this way there is more space inside them and hence less resistance. This makes it easier for the heart to pump blood around the body.
Widening the veins also decreases the volume of blood that returns to the heart with each heartbeat. This makes it easier for the heart to pump that blood out again.
As a result of both these actions, the heart does not need as much energy to pump the blood around the body and therefore needs less oxygen.
Glyceryl trinitrate also widens the arteries within the heart itself, which increases the blood and oxygen supply to the heart muscle.
The pain of angina is caused by too little oxygen reaching the heart when its workload increases, such as during exercise. Glyceryl trinitrate improves the oxygen supply to the heart, as well as decreasing the amount of oxygen that the heart needs by making it easier for the heart to pump blood around the body. It can therefore be used to treat angina.
Nitrolingual pump spray is sprayed under the tongue. This area of the mouth has a large supply of blood vessels that allows the medicine to be rapidly absorbed. Glyceryl trinitrate taken in this way is used to give rapid relief from the pain of an angina attack. The spray can also be used to prevent an anticipated attack, for example before exercise or physical effort, emotional stress or exposure to cold.
Glyceryl trinitrate is also available as skin patches and ointment that can be applied regularly each day to help prevent angina attacks. See the factsheets linked at the end of this article for more information.
What is it used for?
- Prevention and relief of angina attacks.
How do I use it?
- Always use this medicine exactly as your doctor has told you and follow the instructions in the information leaflet provided with the spray. If you are unclear about anything you can ask your pharmacist or doctor for advice.
- It is best to sit down and rest while you are using the spray as otherwise it can make you feel dizzy.
- If the pump is new, or has not been used for a week or more, you should spray it once into the air before using it.
- The spray is to be administered under your tongue - it should not be inhaled. You don't need to shake the bottle before use. Hold the bottle upright next to your chin with your finger on the button. Open your mouth, lift your tongue and press the button down firmly to spray the medicine under your tongue. Close your mouth after you have sprayed the dose under the tongue.
- To relieve an angina attack the usual dose is one or two sprays under your tongue. If your chest pain doesn't improve within five minutes of this first dose you can repeat it twice at five minute intervals. If your symptoms don't improve after three doses you should get medical attention straight away.
- To prevent an angina attack the usual dose is one or two sprays under the tongue immediately before you do the activity that is likely to bring on an angina attack, for example before doing exercise or going out in the cold.
- Make sure you keep the spray with you at all times in case you need to use it.
- Follow the instructions you receive with this medicine. Glyceryl trinitrate spray should be sprayed under the tongue. Do not inhale the spray.
- This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance. If you do feel dizzy after taking a dose, sit or lie down until the symptoms pass.
- Drinking alcohol may enhance some of the side effects of this medicine, such as feeling faint or dizzy.
Use with caution in
- Severely decreased kidney function.
- Severely decreased liver function.
- People who have recently had a heart attack.
- People with low levels of oxygen in their blood, eg due to lung disease or right-sided heart failure.
- People with an underactive thyroid gland (hypothyroidism).
- People who are malnourished.
- People with dangerously low body temperature (hypothermia).
- People with raised pressure in the eyeball or glaucoma.
Not to be used in
- People who are allergic to nitrates.
- People with very low blood pressure (hypotension).
- People with a low volume of circulating blood (hypovolaemia), for example due to severe bleeding.
- People with heart disease involving thickening of the heart muscle (hypertrophic obstructive cardiomyopathy).
- People with inflammation of the sac surrounding the heart that stops the heart from beating properly (constrictive pericarditis).
- People with fluid in the sac surrounding the heart that prevents the heart beating properly (cardiac tamponade).
- People with narrowing of the main artery leaving the heart (aortic stenosis).
- People with narrowing of one of the valves in the heart (mitral valve stenosis).
- People with raised pressure inside the skull, for instance due to a head injury or bleeding in the brain (cerebral haemorrhage).
- People with severe anaemia.
- This medicine is not recommended for use in children.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine is not known to be harmful if used during pregnancy. However, it should only be used during pregnancy if the benefits to the mother outweigh any possible risks to the developing baby. Seek further medical advice from your doctor.
- It is not known if this medicine passes into breast milk. It should be used with caution in breastfeeding mothers and only if the benefits to the mother outweigh any risks to the nursing infant. Seek further medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
Very common (affect more than 1 in 10 people)
Common (affect between 1 in 10 and 1 in 100 people)
- Drop in blood pressure that causes dizziness when getting up from lying down or sitting (postural hypotension).
- Increased heart rate (tachycardia).
- Flushing of the face.
- Feeling weak.
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Nausea and vomiting.
- Decreased heart rate (bradycardia).
- Worsening of angina symptoms (get urgent medical attention if you experience this).
- Allergic skin reactions.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think its necessary they'll report it for you.
You can also report side effects yourself using the yellow card website: www.mhra.gov.uk/yellowcard.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
The medicines for erectile dysfunction (impotence) listed below must not be used by people who take glyceryl trinitrate, because the combination can produce a severe drop in blood pressure resulting in dizziness, fainting, or even a heart attack:
- avanafil (Spedra)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra).
If this medicine is taken in combination with other medicines that reduce blood pressure, either as a treatment for high blood pressure (antihypertensives), or as a side effect, there may be an enhanced blood pressure lowering effect. This might make some people feel dizzy. If you do feel dizzy, you should lie down until the symptoms pass. Other medicines that can reduce blood pressure include the following:
- ACE inhibitors, eg enalapril, captopril
- alpha blockers, eg alfuzosin, doxazosin
- angiotensin II receptor antagonists, eg losartan
- certain antipsychotic medicines, eg chlorpromazine
- benzodiazepines, eg temazepam
- beta-blockers, eg propranolol
- calcium-channel blockers, eg diltiazem, verapamil, nifedipine
- diuretics, eg furosemide
- MAOI antidepressants, eg phenelzine
- other nitrates, eg isosorbide mononitrate, amyl nitrate (poppers)
- tricyclic antidepressants, eg amitriptyline.
Other medicines containing the same active ingredient
- Coro-Nitro pump spray.
- Deponit patches.
- Glytrin spray.
- GTN sublingual tablets.
- Minitran patches.
- Nitrocine injection.
- Nitro-Dur patches.
- Nitromin spray.
- Nitronal injection.
- Percutol ointment.
- Transiderm-nitro patches.
Glyceryl trinitrate sublingual tablets, sprays and injection are also available without a brand name, ie as the generic medicine.
For background information about our medicine factsheets, including the references used to produce them, click here.