Alternatives to Nitrostat If You Can't Fill Your Prescription

Nitrostat (nitroglycerin 0.3–0.6 mg sublingual tablets) is the most widely prescribed fast-acting rescue medication for angina. But what happens when your pharmacy doesn't have it in stock? Understanding your options before that situation arises can make a critical difference.

Important: Never switch medications on your own. Always talk to your doctor before making any changes to your angina treatment plan. Angina is a serious cardiac condition, and medication decisions require professional guidance.

Understanding What Nitrostat Is Used For

Nitrostat serves two distinct purposes: it is used to acutely relieve an angina attack (onset in 1–3 minutes), and it can be taken prophylactically 5–10 minutes before activities known to cause chest pain. Any alternative must match the use case — a prevention medication cannot substitute for a rescue medication.

Best Alternative for Acute Relief: Nitroglycerin Lingual Spray

If you can't find Nitrostat sublingual tablets, the closest direct substitute is nitroglycerin lingual spray. Brand names include Nitrolingual Pumpspray and NitroMist. These products deliver nitroglycerin directly to the mucous membranes of the mouth and have a comparable onset of action to sublingual tablets — relief begins within 1 to 3 minutes.

How it's used: Spray 1 or 2 doses onto or under the tongue at the onset of an attack; may repeat every 5 minutes, up to 3 doses in 15 minutes

Advantage: Longer shelf life than tablets (do not have the 6-month open-bottle expiration); easier to use for patients with dry mouth

Availability: Often stocked separately from tablets; check availability using medfinder if tablets are unavailable

For Angina Prevention: Isosorbide Mononitrate (Imdur)

Isosorbide mononitrate is a long-acting nitrate taken once daily (or twice daily in immediate-release form) to prevent angina episodes. It works through the same nitric oxide pathway as nitroglycerin and is an excellent option for patients who primarily use Nitrostat for prevention rather than acute rescue.

Important: Isosorbide mononitrate cannot replace Nitrostat as a rescue medication. It does not act fast enough for acute attacks.

Typical dose: 10–20 mg twice daily (immediate release) or 30–120 mg once daily (extended release)

Availability: Available as generic; widely stocked at most pharmacies

Another Nitrate Option: Isosorbide Dinitrate (Isordil)

Isosorbide dinitrate (Isordil) is available in oral and sublingual forms. The sublingual form (5 mg) provides relatively fast relief — not quite as rapid as nitroglycerin, but faster than the oral tablet. It can serve as a bridge rescue option when Nitrostat tablets are unavailable, though your doctor must confirm the appropriate dose.

Onset: Slightly slower than nitroglycerin (a few minutes longer due to hepatic conversion to mononitrate)

Duration: Longer than nitroglycerin — 4 to 6 hours versus 25 minutes for Nitrostat

Non-Nitrate Options for Chronic Angina Prevention

If you're primarily managing chronic stable angina and the concern is about a prevention strategy rather than acute rescue, your doctor may consider non-nitrate medications:

Beta-blockers (metoprolol, atenolol): First-line agents for angina prevention; reduce heart rate and cardiac workload; not for acute attacks

Calcium channel blockers (amlodipine, diltiazem): Especially effective for vasospastic (Prinzmetal's) angina; used for prevention

Ranolazine (Ranexa): Works through a different mechanism (late sodium current inhibition); used as add-on therapy for chronic angina; not for acute attacks

Summary: Quick Reference Chart

Here's a quick overview of alternatives and their primary uses:

Nitroglycerin spray: Best direct substitute for acute rescue; same fast onset, different form

Isosorbide Mononitrate: Best for daily prevention; not for acute attacks

Sublingual Isosorbide Dinitrate: Moderate-speed rescue option; longer duration than Nitrostat

Beta-blockers / CCBs / Ranolazine: Prevention only; used in combination with a fast-acting rescue agent

If your pharmacy doesn't have Nitrostat, try medfinder to locate it at a pharmacy near you, or read our full guide: How to find Nitrostat in stock near you.