I have a deep and abiding respect for nitrates, since I believe these drugs kept me alive during my heart attack in 1978. I experienced that heart attack the night before my scheduled angiogram, and fortunately my cardiologist had put me on a high dosage of nitrates, which are designed to keep the arteries open. Without the effects of those drugs, my attack might very well have been worse.
The nitrates are used mainly for acute relief and prevention of angina pectoris. They work by relaxing the smooth muscle tissue of the blood vessels, resulting in dilation of both veins and arteries. This, in turn, yields increased blood flow and decreased oxygen consumption by the heart. Another effect may be a reduction in both systolic and diastolic blood pressure.
There are a number of ways to deliver nitrates, for either long-term or short-term benefits. Glyceryl trinitrate, more commonly known as nitroglycerin and which I’ll discuss in more detail in a moment, provides a quick burst of vasodilation, but the vessel-opening effect doesn’t last long. The long-term nitrates don’t have as dramatic an effect, but they keep the vessels open over a longer period of time. Your doctor may prescribe one or more of the nitrates, to be taken as tablets (swallow, don’t chew), ointment, skin patches or sprays.
Contraindications include severe anaemia, head trauma, cerebral haemorrhage, and hypersensitivity to nitrates. The drugs can result in postural hypotension, that is, dizziness which occurs when you change position suddenly, such as standing up from a seated position. Since alcohol makes this tendency worse, it’s best to avoid or limit drinking. Large nitrate dosage can produce headaches. Talk with your doctor if headache develops; often patients become more tolerant to nitrates.
If you experience angina pectoris, your doctor will very likely prescribe nitroglycerin, either alone or in addition to other nitrates. It enables the heart muscle to get more blood which, in turn, provides more oxygen and relieves the pain.
Unless instructed otherwise, place a nitroglycerin tablet under your tongue at the start of chest pain. You may experience a dull headache, one of the ways you know that the nitroglycerin has gotten into your bloodstream. If your chest pain doesn’t go away within five minutes, take another tablet. If pain still persists, after another five minutes take a third tablet. And if that doesn’t work, contact your physician. For severe or worsening pain, seek immediate medical attention.
Dr Nishi offers these tips regarding nitroglycerin usage:
Do not drink water with this pill, and don’t swallow it. Let it dissolve under your tongue.
It’s best to sit down or lie down when taking nitroglycerin, as it
may cause a temporary drop in blood pressure and resulting dizziness.
Don’t be concerned about normal side effects including headache, dizziness, a warm flushed feeling and a burning sensation under the tongue.
This medication can easily lose its potency. Don’t store in a hot or even very warm place, and keep it out of the sun. Keep nitroglycerin in its original, brown glass container. Studies have shown that even the heat generated by keeping the container in a shirt pocket next to the skin is enough to destroy nitroglycerin’s potency.
Replace opened bottles of nitroglycerin at least every six months. Properly stored, unopened bottles should be good until the expiration date on the label.
If you don’t get the dull headache that typically occurs when taking nitroglycerin, assume that the pills have lost their potency.
Keep the bottle top tightly closed.
As with all other medications, discuss nitroglycerin with your doctor or pharmacist. Dr Nishi recalls a patient who claimed he had no questions, and fully understood all his medications. Then the pharmacist spotted the patient’s nitroglycerin on a windowsill in direct sunlight. After mentioning that, a 15- to 20-minute discussion and Q&A session followed.
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Cardio & Blood/ Cholesterol
