Your Patients Are Struggling to Find Nitroglycerin — Here's How You Can Help

If you prescribe Nitroglycerin, you've probably fielded calls from frustrated patients who can't get their prescription filled. The ongoing Nitroglycerin shortage — particularly affecting sublingual tablets — has created a real access problem for patients with angina and coronary artery disease. As a provider, you're in a unique position to help.

This guide provides practical, actionable steps you can incorporate into your clinical workflow to help patients locate Nitroglycerin, navigate alternative formulations, and avoid dangerous gaps in their anti-anginal therapy.

Current Availability Landscape

Understanding the supply picture helps you make better prescribing decisions. Here's where things stand in early 2026:

• Sublingual tablets (Nitrostat/generics): Most affected. Intermittent availability. Pfizer remains the dominant manufacturer with few generic competitors. Regional variation is significant.
• Translingual spray (Nitrolingual, Nitromist): Generally better availability. Different manufacturing and distribution channels than tablets. Equivalent efficacy for acute angina.
• Transdermal patches (Nitro-Dur, Minitran, generics): Most consistently available. Multiple generic manufacturers. Primary option for prophylactic therapy.
• Injectable (IV): Intermittent hospital supply. Institutional alternatives (IV nitroglycerin from alternate suppliers, nitroprusside for select indications) should be protocolized.

For the full shortage background, see our clinical briefing: Nitroglycerin shortage: What providers need to know in 2026.

Why Patients Can't Find It

Several factors compound the supply problem from the patient's perspective:

• Chain pharmacy allocation: Major chains receive centrally allocated inventory that may not match local demand. Stores in high-density cardiac populations may run out faster.
• Lack of real-time information: Patients call pharmacies one at a time, often getting outdated information. By the time they arrive, stock may be gone.
• Prescription lock-in: Patients often stick with their usual pharmacy even when it's consistently out of stock, not realizing they can transfer prescriptions easily.
• Formulation inflexibility: If you prescribed sublingual tablets specifically, a pharmacy can't substitute the spray without a new prescription — even though both deliver Nitroglycerin 0.4 mg sublingually/translingually.

5 Steps You Can Take Today

Step 1: Check Availability Before Prescribing

MedFinder for Providers allows you or your staff to check real-time Nitroglycerin availability at pharmacies near your patient's home or workplace. Incorporate this into your e-prescribing workflow:

1. Before sending a prescription, check MedFinder for pharmacies with current stock
2. Send the prescription to a pharmacy confirmed to have the medication
3. If your patient's preferred pharmacy is out, discuss alternatives with the patient before they leave the office

This single step can prevent the most common patient complaint: "I went to my pharmacy and they didn't have it."

Step 2: Prescribe Multiple Formulations

Consider prescribing both sublingual tablets and the translingual spray to give patients a backup option. You can:

• Write the primary prescription for sublingual Nitroglycerin 0.4 mg tablets
• Write a second prescription for Nitroglycerin translingual spray 0.4 mg (Nitrolingual or Nitromist) with a note: "Fill if tablets unavailable"
• Educate the patient that both formulations work equivalently for acute angina relief

For patients using Nitroglycerin for prophylaxis, ensure they have a patch prescription and a rescue medication prescription. Don't assume they'll figure out the alternative on their own.

Step 3: Educate Patients on Formulation Equivalence

Many patients don't know that Nitroglycerin spray exists or that it works the same way as their sublingual tablets. Take 30 seconds during the visit to explain:

• "The spray works just as fast and just as well as the tablet under your tongue"
• "You spray it onto or under your tongue — don't inhale it"
• "The canister lasts longer than a bottle of tablets and doesn't degrade as quickly"

Proactive education prevents panic if the patient's usual formulation becomes unavailable.

Step 4: Have a Backup Plan Ready

For patients with chronic stable angina, document an alternative prescribing plan in the chart:

• If sublingual NTG unavailable: Switch to NTG translingual spray 0.4 mg PRN chest pain
• If all NTG formulations unavailable: Consider SL Isosorbide Dinitrate 2.5-5 mg PRN (slower onset but acceptable alternative)
• If NTG patch unavailable: Switch to Isosorbide Mononitrate ER 30-60 mg daily

Having this documented means a nurse or pharmacist can act quickly if the patient calls about a supply problem, without requiring a full provider callback.

Step 5: Direct Patients to Self-Service Resources

Empower patients with resources they can use independently:

• MedFinder: medfinder.com — check pharmacy stock in real time
• Finding Nitroglycerin guide: How to find Nitroglycerin in stock near you
• Cost savings: How to save money on Nitroglycerin
• Alternatives overview: Alternatives to Nitroglycerin

Consider adding these links to your patient discharge instructions or after-visit summary for any patient with an active Nitroglycerin prescription.

Alternative Medications to Consider

When Nitroglycerin is truly unavailable in any formulation, these alternatives can help bridge the gap:

Same-Class Nitrates

• Isosorbide Mononitrate ER (Imdur): 30-120 mg once daily. Excellent for prophylaxis. Widely available, $10-$30/month generic. Does not replace rescue NTG for acute episodes.
• Isosorbide Dinitrate (Isordil): 10-40 mg BID-TID with nitrate-free interval. Sublingual form (2.5-5 mg) can serve as semi-acute alternative. $15-$40/month generic.

Non-Nitrate Alternatives

• Ranolazine (Ranexa): 500-1000 mg BID. Add-on therapy for patients with refractory angina. Does not cause hypotension. $30-$100/month generic.
• Calcium channel blockers: Amlodipine 5-10 mg daily or Diltiazem ER 120-360 mg daily. First-line for vasospastic (Prinzmetal) angina. Excellent adjunctive therapy.

For more detail on alternatives, see our clinical briefing: Nitroglycerin shortage: What providers need to know in 2026.

Workflow Tips for Your Practice

Here are practical workflow adjustments to manage the Nitroglycerin shortage efficiently:

• Flag charts: Add a clinical reminder for patients on Nitroglycerin to check supply status at each visit.
• Pre-visit planning: Have your MA or nurse ask about medication access when rooming the patient. "Are you able to fill all your prescriptions without difficulty?"
• Template prescriptions: Create order sets or favorites in your EHR for the NTG spray and Isosorbide Mononitrate so they're easy to prescribe as alternatives.
• Pharmacy relationships: Identify 2-3 pharmacies in your area that tend to have better Nitroglycerin stock (often independents) and recommend them to patients.
• Follow-up protocol: For patients who report access problems, schedule a brief phone or portal follow-up within 1 week to ensure they obtained medication.

Helping Patients With Cost Concerns

The shortage can also create cost issues when patients must switch to pricier formulations. Help patients access savings by:

• Recommending discount card programs (GoodRx, SingleCare, RxSaver)
• Connecting uninsured patients with Pfizer RxPathways or NeedyMeds
• Checking formulary coverage before prescribing alternative formulations

See our provider guide: How to help patients save money on Nitroglycerin.

Final Thoughts

The Nitroglycerin shortage creates unnecessary risk for your patients with angina. By incorporating availability checks, prescribing flexibly, educating patients proactively, and maintaining documented backup plans, you can significantly reduce the impact of supply disruptions on patient care.

MedFinder for Providers is designed specifically to help with situations like this — real-time availability data at your fingertips. Pair it with the clinical strategies above, and your patients will be far better positioned to access the anti-anginal therapy they need.

Share our patient-facing shortage update with your patients: Nitroglycerin shortage: What patients need to know in 2026.