Alternatives to Nitro-Bid: What to Know

If you have been prescribed Nitro-Bid (Nitroglycerin 2% ointment) and cannot find it at your pharmacy, you are probably wondering what your options are. The good news is that several effective alternatives exist for preventing angina.

This article covers the most common alternatives to Nitro-Bid, how they compare, and what to discuss with your doctor. For background on why Nitro-Bid is hard to find, see our article: Why is Nitro-Bid so hard to find?

Important: Never switch medications on your own. Always talk to your doctor before making any changes to your treatment plan.

Understanding Nitro-Bid and How It Works

Nitro-Bid is a topical Nitroglycerin ointment used to prevent angina (chest pain) caused by coronary artery disease. It works by relaxing blood vessels, which reduces the workload on your heart. You apply it to your skin, and the medication absorbs into your bloodstream over several hours.

When looking for alternatives, your doctor will consider medications that work in a similar way — reducing your heart's oxygen demand and improving blood flow to the heart muscle. For a deeper look at how Nitro-Bid works, see How does Nitro-Bid work?

Alternative 1: Nitroglycerin Transdermal Patches

Brand names: Nitro-Dur, Minitran

Nitroglycerin patches are the closest alternative to Nitro-Bid. Like the ointment, patches deliver Nitroglycerin through the skin. The main differences are convenience and dosing precision.

How they work: You apply a patch to clean, dry skin once a day. The patch releases a steady dose of Nitroglycerin over 12-14 hours. You remove it for 10-12 hours overnight to prevent tolerance (the same nitrate-free interval required with Nitro-Bid).

Pros:

• Easier to apply — no measuring ointment
• More precise dosing
• More widely available than Nitroglycerin ointment
• Less messy

Cons:

• Less flexibility in dose adjustment (patches come in fixed doses)
• May cause skin irritation at the application site
• Typically more expensive than generic ointment

Availability: Nitroglycerin patches are generally easier to find than the ointment form. Both brand-name and generic versions are available at most pharmacies.

Alternative 2: Isosorbide Mononitrate (Imdur)

Isosorbide Mononitrate is an oral nitrate medication taken by mouth. It is one of the most commonly prescribed long-acting nitrates for angina prevention.

How it works: Like Nitroglycerin, it relaxes blood vessels and reduces the heart's workload. The extended-release form (Imdur) is taken once daily in the morning.

Pros:

• Taken by mouth — no skin application needed
• Once-daily dosing (extended-release)
• Widely available and inexpensive as a generic
• Well-studied with a long track record

Cons:

• Headaches are common, especially when starting treatment
• Cannot be used for acute angina attacks
• Tolerance can still develop if not dosed correctly

Availability: Generic Isosorbide Mononitrate is widely available at very low cost. It is one of the easiest nitrate medications to find.

Alternative 3: Isosorbide Dinitrate (Isordil)

Isosorbide Dinitrate is another oral nitrate option. It has been used for decades to treat and prevent angina.

How it works: Similar mechanism to other nitrates — relaxes blood vessels and reduces cardiac workload. It is typically taken 2-3 times per day with a nitrate-free interval.

Pros:

• Oral tablet — easy to take
• Available as a generic
• Long history of clinical use

Cons:

• Requires multiple daily doses
• More complex dosing schedule to maintain nitrate-free interval
• Headaches common

Availability: Generally available, though not as commonly prescribed as Isosorbide Mononitrate.

Alternative 4: Nitroglycerin Sublingual Tablets (Nitrostat)

Sublingual Nitroglycerin tablets are placed under the tongue to treat acute angina attacks. They are not a direct replacement for Nitro-Bid because they are used for quick relief rather than prevention.

However, if your doctor determines that your angina can be managed with as-needed treatment rather than continuous prevention, sublingual Nitroglycerin might be part of your plan.

Note: Most patients who were on Nitro-Bid for prevention will need a long-acting alternative, not just as-needed sublingual tablets.

Other Angina Medications

If nitrate medications are not suitable for you, your doctor may consider other types of angina prevention drugs:

• Beta-blockers (Metoprolol, Atenolol) — reduce heart rate and blood pressure
• Calcium channel blockers (Amlodipine, Diltiazem) — relax blood vessels and reduce heart workload
• Ranolazine (Ranexa) — works differently from nitrates; can be added to other angina medications

These are not nitrates and work through different mechanisms, but they may be effective alternatives for angina prevention depending on your situation.

How to Talk to Your Doctor

If you cannot find Nitro-Bid, bring this up with your doctor as soon as possible. Here are some questions to ask:

• "Can I switch to a Nitroglycerin patch instead of the ointment?"
• "Would Isosorbide Mononitrate work for me?"
• "Are there any reasons I should not use these alternatives?"
• "Should I try a compounding pharmacy for Nitroglycerin ointment first?"

Your doctor will consider your overall health, other medications you take (especially drug interactions to avoid), and your personal preferences when recommending an alternative.

Important Safety Reminder

All nitrate medications share certain drug interactions. You must never take any nitrate medication with PDE-5 inhibitors like Sildenafil (Viagra), Tadalafil (Cialis), or Vardenafil (Levitra). This combination can cause a dangerous drop in blood pressure. Make sure your doctor knows about all medications you are taking.

Still Want to Find Nitro-Bid?

If you prefer to stay on Nitroglycerin ointment, do not give up on finding it. Use MedFinder to search for pharmacies with current stock, or read our guide on how to find Nitro-Bid in stock near you for more strategies.

The Bottom Line

If you cannot fill your Nitro-Bid prescription, you have several good alternatives. Nitroglycerin patches are the most similar option, while oral medications like Isosorbide Mononitrate offer convenience and wide availability. Talk to your doctor about which alternative is right for you, and never switch medications without medical guidance.

For more on saving money on whichever medication you end up using, check out our guide on how to save money on Nitro-Bid and its alternatives.