What Are Nitrates? Drug List, Side Effects & Pregnancy Safety

What are nitrates (nitrate
medications)?

Nitrates are medications used for treating or preventing heart pain (angina, chest pain)
caused by heart disease, usually of the arteries in the heart.

What are examples of nitrates available in the United States?

Examples of generic and brand names of nitrates include:

• nitroglycerin sublingual tablet
  (Nitrostat)
• nitroglycerin lingual aerosol
  (Nitromist)
• nitrolinglycerin pumpspray
  (Nitrolingual Pumpsprapy)
• nitroglycerin lingual (Nitrolingual
  Pumpspray)
• nitroglycerin transdermal ointment
  (Nitro-Bid)
• nitroglycerin transdermal infusion
  system (Nitro-Dur)
• nitroglycerin transdermal therapeutic
  system (Transderm-Nitro)
• Nitroglycerin oral capsule (Nitro-Time)
• nitroglycerin intravenous
• isosorbide mononitrate
  and dinitrate
  (Isordil, Isordil Titradose, Dilatrate-SR))

What are the side effects of nitrates?

Common side effects of nitrates include:

• Headache

• Dizziness

• Lightheadedness

• Nausea

• Flushing
• Burning and tingling under the tongue

• Low blood pressure

Other side effects include:

• Skin irritation

• Itching

• Topical
  allergic
  reactions may also occur with the topical patch form

Are nitrates safe to take during pregnancy or while breastfeeding?

• The FDA classifies nitrates as
  pregnancy category C, which means that safe
  and effective use of nitrates in
  pregnant women has not been established.
  Nitrates should be given to pregnant women only if clearly needed.
• It is not known whether nitrates enter breast milk; therefore, nitrates must
  be used with caution in women who are
  breastfeeding.

What drugs interact with nitrates?

• Nitrates can slow down metabolism of
  cabergoline and ergonovine, resulting in
  an increase in systolic
  blood pressure and an increased likelihood of angina
  symptoms.
• Sildenafil (Viagra),
  tadalafil (Cialis) and
  vardenafil (Levitra) increase the
  blood pressure lowering effects of nitrates and may cause excessive blood
  pressure reduction. Men taking nitrates should not take sildenafil
  (Viagra), tadalafil (Cialis), or vardenafil (Levitra).

What
preparations of nitrates are available?

Nitrates are available in various formulations. Nitroglycerin is available
in:

• oral capsule
• sublingual tablet
• sublingual spray
• intravenous solution
• topical ointment
• topical patch
• isosorbide mononitrate and isosorbide
  dinitrate are available as immediate and extended-release tablets

Only sublingual tablets, intravenous, or immediate release tablets are used
for immediate treatment of angina because the onset of action of the other
formulations is not fast enough.

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How do nitrates work?

Nitrates are
vasodilators (dilators of blood vessels that increase their diameter) that allow
blood to flow more easily. Blood returning from the body in the veins must be
pumped by the heart through the lungs and into the body's arteries against the
high pressure in the arteries. In order to accomplish this work, the heart's
muscle must produce and use energy ("fuel"), and this requires consumption of
oxygen that is supplied by the blood. Angina (angina pectoris or "heart pain")
is due to an inadequate flow of blood (and oxygen) to the muscle of the heart.

Nitrates, including isosorbide dinitrate, increase the flow of blood and
oxygen to the heart and thereby increase the amount of work that the heart can
do by dilating (expanding) the arteries and veins in the body. Dilation of the
veins reduces the amount of blood that returns to the heart that must be pumped,
while dilation of the arteries lowers the pressure in the arteries against which
the heart must pump. As a consequence of both effects, the heart works less and
requires less blood and oxygen.