Can't find Nitroglycerin? Learn about alternative medications your doctor may prescribe, including Isosorbide Mononitrate, Isosorbide Dinitrate, and Ranolazine.
If you've been searching for Nitroglycerin and coming up empty, you're not alone. Ongoing supply shortages have left many patients without this critical heart medication. While finding Nitroglycerin in stock should always be your first priority (try MedFinder to check nearby pharmacies), it's important to know that alternatives exist.
This article covers the medications your doctor might consider if you can't get Nitroglycerin, how they compare, and what you should know about each one. Important: Never switch medications on your own. Always talk to your doctor before starting or stopping any heart medication.
Nitroglycerin is an organic nitrate that has been used to treat heart-related chest pain (angina) for over 130 years. It works by converting to nitric oxide in your body, which relaxes and widens blood vessels. This reduces the workload on your heart and improves blood flow to the heart muscle.
Nitroglycerin comes in several forms:
For a complete overview of Nitroglycerin, visit our guide: What is Nitroglycerin? Uses, dosage, and what you need to know. To understand how the drug works at a deeper level, see How does Nitroglycerin work? Mechanism of action explained.
Isosorbide Mononitrate is the most commonly prescribed alternative to Nitroglycerin for angina prevention. It's in the same drug class (organic nitrates) and works through the same mechanism — releasing nitric oxide to relax blood vessels.
Isosorbide Mononitrate is excellent for preventing angina but does not work fast enough to treat an acute chest pain episode. If you currently use Nitroglycerin sublingual tablets as a rescue medication, Isosorbide Mononitrate alone is not a complete replacement — you would still need a fast-acting option for breakthrough pain.
However, if you're mainly using Nitroglycerin patches for prevention, switching to Isosorbide Mononitrate may be straightforward. It's widely available, affordable, and well-studied.
Isosorbide Dinitrate is another nitrate medication closely related to Nitroglycerin. It's available in multiple forms and has been used for decades.
The sublingual form of Isosorbide Dinitrate can act relatively quickly (within a few minutes), making it a closer substitute for sublingual Nitroglycerin than the mononitrate form — though it's still not quite as fast-acting. The oral forms are used for prevention. Like all nitrates, it requires a daily nitrate-free period to prevent tolerance.
Ranolazine is a non-nitrate anti-anginal medication that works through a completely different mechanism. It inhibits the late sodium current in heart cells, which reduces the calcium overload that contributes to chest pain.
Ranolazine is typically used as an add-on therapy or for patients who can't tolerate nitrates. It doesn't cause the blood pressure drops that nitrates do, which can be an advantage for some patients. However, it is not a rescue medication — it won't relieve acute chest pain like sublingual Nitroglycerin. It's used for long-term angina prevention.
Calcium channel blockers are a different class of heart medication that can help prevent angina by relaxing blood vessels and reducing the heart's workload.
Calcium channel blockers are used for angina prevention, not acute relief. They're often prescribed alongside Nitroglycerin rather than as replacements. However, for patients who primarily need preventive therapy and can't access Nitroglycerin patches, a calcium channel blocker may fill that role.
Here's the critical distinction that every patient should understand:
If you're unable to find sublingual Nitroglycerin tablets, Nitroglycerin spray (Nitrolingual or Nitromist) is the closest direct substitute and should be your first ask. The spray uses a different delivery system but provides the same fast-acting relief.
If you're having trouble finding Nitroglycerin, bring it up with your doctor proactively. Here's a simple script:
"I haven't been able to find Nitroglycerin sublingual tablets at my pharmacy. They've been out of stock for [timeframe]. Can we discuss alternative formulations or medications I could use while the shortage continues?"
Your doctor can then evaluate your specific situation — how often you have angina, whether you need a rescue medication, what other heart drugs you're already taking — and recommend the best alternative for you. To find a doctor who can help, visit our guide on how to find a doctor who can prescribe Nitroglycerin near you.
While alternatives can help bridge the gap, Nitroglycerin remains the gold standard for acute angina relief. Continue checking for availability using MedFinder and review our tips on how to find Nitroglycerin in stock near you.
Not being able to fill your Nitroglycerin prescription is stressful, especially when you rely on it for your heart health. The good news is that effective alternatives exist for angina prevention, and your doctor can help you find the right bridge therapy while supply catches up. For fast-acting relief, ask about Nitroglycerin spray as your first alternative. For prevention, Isosorbide Mononitrate, Isosorbide Dinitrate, Ranolazine, and calcium channel blockers are all viable options.
Be sure to also check our articles on Nitroglycerin side effects and Nitroglycerin drug interactions to stay fully informed about your medication options.
You focus on staying healthy. We'll handle the rest.
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