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Nitrolingual pump spray (glyceryl trinitrate) is used to help the heart work more easily by using a nitrate. Glyceryl Trinitrate worky by converted in the body to a chemical called Nitric Oxide. The body ios known to make this chemical naturally which makes arteries and veins relax (widen and dilate) providing an increase in space inside them and creates less resistance. What this accomplishes is the heart pumps blood around the body more easily. Once the Nitrolingual has begun working and the blood is flowing more freely the widening of the veins also decreases the blood volume that goes back to the heart making it easier on the heart when it pumps the 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. The use of any form of glyceryl trinitrate during the early days of acute myocardial infarction requires particular attention to haemodynamic monitoring and clinical status.

Nitrolingual Pump Spray Side Effects:

Because Nitrolingual Spray is more stable than glyceryl trinitrate tablets, it is possible that some patients transferred to the spray will receive a larger dose of the drug than usual. This may increase possible side effects, eg. headache ( see Adverse Reactions ). General: Severe hypotension, particularly with upright posture, may occur even with small doses of glyceryl trinitrate. The drug, therefore, should be used with caution in subjects with may have volume depletion from diuretic therapy or in patients who have low systolic blood pressure (eg. below 90 mmHg). Paradoxical bradycardia and increased angina pectoris may accompany glyceryl trinitrate induced hypotension. Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy.

Tolerance: Tolerance to this drug and cross tolerance to other nitrates and nitrites may occur. Tolerance to the vascular and antianginal effects of nitrates has been demonstrated in clinical trials, experience through occupational exposure, and in isolated tissue experiments in the laboratory. Intermittent therapy, such as with Nitrolingual Spray, will reduce the likelihood of tolerance developing to glyceryl trinitrate. Withdrawal: Various clinical trials in angina patients indicate that withdrawal of glyceryl trinitrate may cause rebound of haemodynamic effect and a more ready provocation of anginal attack. Hypoxaemia: Arterial oxygen tension decreases after administration of glyceryl trinitrate in normal subjects and in patients with coronary artery disease. Caution should be observed in patients with severe ischaemic heart disease as a decrease in available oxygen may oppose its antianginal effect. Methaemoglobinaemia: Methaemoglobinaemia has been reported in association with high doses of glyceryl trinitrate therapy. This may be clinically significant, especially in the presence of methaemoglobin reductase deficiencies or in congenital methaemoglobin variants. Use in Pregnancy: [(Category B2) 3rd edition "Medicines in Pregnancy"{Australia}] The safety of glyceryl trinitrate administered to women who are or who may become pregnant has not been established. Therefore, Nitrolingual Spray should not be given to pregnant women unless, in the judgment of the doctor, the expected benefit outweighs any potential risk. Use in lactation: It is not known whether glyceryl trinitrate is excreted in human milk. Caution is advised when glyceryl trinitrate is administered to a breastfeeding mother. Use in children: The safety and effectiveness of glyceryl trinitrate in children have not been established. NITROLINGUAL is presumed to be safe or unlikely to produce an effect on the ability to drive or use machinery.