How does it work?

Nitrolingual pump spray contains the active ingredient glyceryltrinitrate, which is a type of medicine called a nitrate. It is used to helpthe heart work more easily. (NB. Glyceryl trinitrate is also available withouta brand name, ie as thegeneric medicine.)

Glyceryl trinitrate works by being converted in the body to achemical called nitric oxide. This chemical is made naturally by the body andhas the effect of making the veins and arteries relax and widen (dilate). Whenthe blood vessels dilate in this way there is more space inside them and henceless resistance. This makes it easier for the heart to pump blood around thebody.

Widening the veins also decreases the volume of blood thatreturns to the heart with each heartbeat. This makes it easier for the heart topump that blood out again.

As a result of both these actions, the heart does not need asmuch energy to pump the blood around the body and therefore needs lessoxygen.

Glyceryl trinitrate also widens the arteries within the heartitself, which increases the blood and oxygen supply to the heartmuscle.

The pain of angina is caused by too little oxygen reaching theheart when its workload increases, such as during exercise. Glyceryl trinitrateimproves the oxygen supply to the heart, as well as decreasing the amount ofoxygen that the heart needs by making it easier for the heart to pump bloodaround the body. It can therefore be used to treat angina.

Nitrolingual pump spray is sprayed under the tongue. This areaof the mouth has a large supply of blood vessels that allows the medicine to berapidly absorbed. Glyceryl trinitrate taken in this way is used to give rapidrelief from the pain of an angina attack. The spray can also be used to preventan anticipated attack, for example before exercise or physical effort,emotional stress or exposure to cold.

Glyceryl trinitrate is also available as long-acting tablets,skin patches and ointment that are used regularly each day to help preventangina attacks. See the factsheets linked at the end of this article for moreinformation.

What is it used for?

• Prevention and relief of angina attacks.

Warning!

• Follow the instructions you receive with this medicine. Glyceryl trinitrate spray should be sprayed under the tongue, and the mouth closed after each dose. 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.
• Underactive thyroid gland (hypothyroidism).
• People with low levels of oxygen in their blood, eg due to lung disease.
• Dangerously low body temperature (hypothermia).
• Malnutrition.

Not to be used in

• Allergy to nitrates.
• Low blood pressure (hypotension).
• Low volume of circulating blood (hypovolaemia).
• Inflammation of the sac surrounding the heart that stops the heart from beating properly (constrictive pericarditis).
• Fluid in the sac surrounding the heart that prevents the heart beating properly (cardiac tamponade).
• Narrowing of the main artery coming from the heart (aortic stenosis).
• Narrowing of one of the valves in the heart (mitral valve stenosis).
• Heart disease in which the muscle of the heart grows abnormally (hypertrophic obstructive cardiomyopathy).
• Head injury.
• Bleeding in the brain (cerebral haemorrhage).
• Severe anaemia.
• Closed angle glaucoma.
• This medicine is not recommended for use in children.

This medicine should not be used if you are allergic to one orany of its ingredients. Please inform your doctor or pharmacist if you havepreviously experienced such anallergy.If you feel you haveexperienced an allergic reaction, stop using this medicine and inform yourdoctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy orbreastfeeding. However, other medicines may be safely used in pregnancy orbreastfeeding providing the benefits to the mother outweigh the risks to theunborn baby. Always inform your doctor if you are pregnant or planning apregnancy, before using any medicine.

• The safety of this medicine for use during pregnancy has not been established. It should only be used during pregnancy if the benefits to the mother outweigh any risks to the developing baby. Seek medical advice from your doctor.
• It is not known if this medicine passes into breast milk. It should only be used by breastfeeding mothers if the benefits to the mother outweigh any risks to the nursing infant. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individualpeople in different ways. The following are some of the side effects that areknown to be associated with this medicine. Just because a side effect is statedhere does not mean that all people using this medicine will experience that orany side effect.

• Headache.
• Dizziness.
• Weakness.
• Nausea.
• Flushing.
• Burning or stinging sensation in the mouth.
• A drop in blood pressure that occurs when moving from a lying down or sitting position to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
• Increased heart rate (tachycardia).
• Decreased heart rate (bradycardia).
• Allergic skin reactions.
• Fainting.

The side effects listed above may not include all of the sideeffects reported by the drug'smanufacturer.For moreinformation about any other possible risks associated with this medicine,please read the information provided with the medicine or consult your doctoror pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicinesyou are already taking, including those bought without a prescription andherbal medicines, before you start treatment with this medicine. Similarly,check with your doctor or pharmacist before taking any new medicines whiletaking this one, to ensure that thecombination is safe.

The medicines for erectile dysfunction (impotence) listed belowmust not be used by people taking glyceryl trinitrate, because the combinationcan produce a severe drop in blood pressure resulting in dizziness, fainting,or even a heart attack:

• sildenafil (Viagra)
• tadalafil (Cialis)
• vardenafil (Levitra).

If this medicine is taken in combination with other medicinesthat reduce blood pressure, either as a treatment for high blood pressure(antihypertensives), or as a side effect, there may be an enhanced bloodpressure lowering effect. This might make some people feel dizzy. If you dofeel dizzy, you should lie down until the symptoms pass. Other medicines thatcan reduce blood pressure include the following:

• ACE inhibitors, eg enalapril, captopril
• alpha blockers, eg alfuzosin, doxazosin
• alprostadil
• anaesthetics
• angiotensin II receptor antagonists, eg losartan
• certain antipsychotic medicines, eg chlorpromazine
• baclofen
• benzodiazepines, eg temazepam
• beta-blockers, eg propranolol
• calcium channel blockers, eg diltiazem, verapamil, nifedipine
• clonidine
• diuretics, eg furosemide
• hydralazine
• levodopa
• MAOI antidepressants, eg phenelzine
• methyldopa
• minoxidil
• moxisylyte
• moxonidine
• other nitrates, eg isosorbide mononitrate, amyl nitrate (poppers)
• tricyclic antidepressants, eg amitriptyline.

Other medicines containing the same active ingredient

Glyceryl trinitrate sublingual tablets, sprays and injection arealso available without a brand name, ie as thegeneric medicine.