Helping Your Patients Find Nitro-Bid: A Provider's Practical Guide

When patients cannot fill their Nitroglycerin ointment prescriptions, they often turn to their prescriber for help. As a provider, you are uniquely positioned to help patients navigate medication access challenges. This guide offers practical workflows, tools, and strategies for helping patients locate Nitro-Bid (Nitroglycerin 2% ointment) or transition to available alternatives.

Understanding the Access Problem

The Nitro-Bid brand has been discontinued by its manufacturer. Generic Nitroglycerin 2% ointment is still produced, but by a limited number of manufacturers. This creates sporadic availability that varies by pharmacy, region, and time. For a detailed overview of the shortage landscape, see our clinical update: Nitro-Bid shortage: What providers and prescribers need to know in 2026.

Patients affected by this shortage are often elderly, may have limited health literacy, and may not know how to navigate the system to find their medication. Your guidance can make a significant difference.

Step 1: Verify the Patient's Current Regimen

Before troubleshooting access, confirm the clinical details:

• Current dose: How many inches of ointment, how many times per day?
• Duration of therapy: How long has the patient been on Nitroglycerin ointment?
• Nitrate-free interval: Is the patient adhering to the recommended 10-12 hour daily break?
• Symptom control: How well controlled is the patient's angina?
• Concurrent medications: Screen for contraindicated interactions (PDE-5 inhibitors, Riociguat).

This information is essential whether you are helping the patient find the ointment or transitioning them to an alternative.

Step 2: Direct Patients to MedFinder

MedFinder is a free tool that helps patients (and providers) search for pharmacies that currently have specific medications in stock. It is the fastest way to identify local availability without making dozens of phone calls.

How to use MedFinder in your practice:

• Recommend the tool directly to patients: "Go to medfinder.com and search for Nitroglycerin ointment with your zip code."
• Have front desk or nursing staff assist patients with the search during office visits.
• Include MedFinder in printed patient instructions for medication access issues.
• Visit medfinder.com/providers for provider-specific resources and workflows.

Step 3: Optimize Prescription Writing

Small changes to how prescriptions are written can improve fill rates:

• Use the generic name: Write "Nitroglycerin ointment 2%" rather than "Nitro-Bid" since the brand is discontinued. Pharmacies search their inventory by generic name.
• Allow substitution: Ensure the prescription permits generic substitution (most states default to this, but confirm).
• Specify compounding when appropriate: If commercial product is unavailable, write a separate prescription specifying compounding.
• Include multiple pharmacy options: With e-prescribing, consider sending the prescription to a pharmacy confirmed to have stock rather than the patient's usual pharmacy.

Step 4: Develop a Contingency Plan

For patients with recurrent access issues, document a contingency plan in the medical record:

• Primary medication: Nitroglycerin ointment 2%, [dose]
• First alternative: Nitroglycerin transdermal patch, [starting dose]
• Second alternative: Isosorbide Mononitrate extended-release, [starting dose]
• Compounding option: Nitroglycerin 2% ointment via compounding pharmacy

This allows your team to respond quickly when patients call about access issues, rather than requiring a full provider visit each time.

Step 5: Coordinate With Pharmacy Staff

Building relationships with pharmacy contacts can streamline medication access:

• Identify pharmacies in your area that regularly stock Nitroglycerin ointment.
• Establish a relationship with a local compounding pharmacy that can prepare Nitroglycerin ointment.
• Communicate with pharmacy staff about patients who will need ongoing access — early notification allows pharmacies to order proactively.

Step 6: Consider Therapeutic Alternatives

When Nitroglycerin ointment is persistently unavailable, transitioning to an alternative formulation may be the best approach for continuity of care. Options include:

• Nitroglycerin transdermal patches: Most similar route of delivery. Start 0.2-0.4 mg/hr, apply 12-14 hours on, 10-12 hours off.
• Isosorbide Mononitrate ER: Oral, once-daily dosing. Start 30-60 mg each morning.
• Isosorbide Dinitrate: Oral, two to three times daily with asymmetric schedule.

For detailed clinical guidance on alternatives, see our provider shortage update.

Patient Communication Tips

How you communicate about medication access issues matters:

• Validate the frustration. Acknowledge that medication shortages are stressful, especially for cardiac patients.
• Reassure about alternatives. Explain that effective alternatives exist and that you will not leave them without treatment.
• Provide written instructions. Give patients a printed card or handout with their medication name, dose, alternatives, and how to use MedFinder.
• Encourage early refills. Advise patients to begin seeking refills one to two weeks before their current supply runs out.

Workflow Integration

Consider integrating medication access support into your practice workflow:

1. Refill requests: When patients call about Nitroglycerin ointment refill issues, have staff check MedFinder and identify pharmacies with stock before routing to the provider.
2. Visit templates: Add a medication access check to visit templates for patients on Nitroglycerin ointment.
3. Patient portal messages: Create a standard response template for medication access inquiries that includes MedFinder links and alternative medication options.
4. EHR alerts: If your EHR supports it, flag patients on Nitroglycerin ointment for proactive outreach about supply issues.

Resources

• MedFinder Provider Portal
• Nitro-Bid shortage: What providers need to know in 2026
• How to help patients save money on Nitro-Bid
• FDA Drug Shortages Database

The Bottom Line

Helping patients find Nitro-Bid requires a combination of tools, proactive planning, and clinical flexibility. By leveraging MedFinder, optimizing prescriptions, developing documented contingency plans, and coordinating with pharmacies, you can minimize disruption to your patients' angina management. When the ointment is truly unavailable, evidence-based alternatives can maintain effective symptom control.