Comprehensive medication guide to Nitroglycerin including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$15 copay; Tier 1–2 generic on most plans, no prior authorization typically required.
Estimated Cash Pricing
$15–$50 for generic sublingual tablets; $30–$90/month for patches; as low as $10–$30 with GoodRx or SingleCare coupons.
Medfinder Findability Score
58/100
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Nitroglycerin is an organic nitrate vasodilator that has been a cornerstone of cardiovascular medicine for over a century. It is primarily used for the acute relief and prevention of angina pectoris (chest pain caused by coronary artery disease). The sublingual tablet form is the classic "heart pill" that patients place under the tongue at the first sign of chest pain.
Beyond angina, Nitroglycerin is also used in hospital settings for acute heart failure, perioperative hypertension, and acute coronary syndromes (IV form). The topical ointment Rectiv is FDA-approved for treating chronic anal fissures. Nitroglycerin is available in multiple formulations including sublingual tablets, sprays, transdermal patches, ointments, sustained-release capsules, and injectable solutions.
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Nitroglycerin is converted to nitric oxide (NO) in smooth muscle cells. Nitric oxide activates an enzyme called guanylate cyclase, which increases levels of cyclic GMP (cGMP). This cascade causes relaxation of vascular smooth muscle.
The primary effect is venous dilation, which reduces the amount of blood returning to the heart (preload). This decreases the heart's workload and oxygen demand. Nitroglycerin also dilates coronary arteries, improving blood flow to ischemic (oxygen-starved) heart muscle. Some arterial dilation also occurs, reducing afterload. The combined effect rapidly relieves angina symptoms, typically within 1–3 minutes for sublingual tablets.
Sublingual tablets
0.3 mg, 0.4 mg, 0.6 mg (Nitrostat and generics)
Translingual spray — spray
0.4 mg per spray (Nitrolingual, Nitromist)
Transdermal patches
0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr (Nitro-Dur, Minitran, generics)
Sustained-release capsules
2.5 mg, 6.5 mg, 9 mg
Topical ointment 2% — topical
Nitro-Bid (angina)
Rectal ointment 0.4% — ointment
Rectiv (anal fissure)
IV solution — solution
5 mg/mL (hospital use only)
Nitroglycerin has faced intermittent shortages since 2023, particularly for sublingual tablets. Pfizer's Nitrostat is the dominant supplier, and manufacturing and supply chain issues have periodically limited availability. The FDA has listed Nitroglycerin sublingual tablets and injectable formulations on its drug shortage list. Transdermal patches and sprays are generally easier to find than sublingual tablets.
If your pharmacy is out of stock, ask about alternative formulations (patches, spray) or try larger chain pharmacies. Use Medfinder to locate Nitroglycerin in stock near you.
Nitroglycerin is commonly prescribed by:
Nitroglycerin is not a controlled substance and does not require specialist prescribing. Telehealth providers can also prescribe it for established patients with documented coronary artery disease.
No. Nitroglycerin is not a controlled substance and has no DEA scheduling. It has no known abuse potential. It can be prescribed by any licensed healthcare provider and filled at any pharmacy without special requirements. Refills are straightforward, and there are no quantity limits imposed by the DEA.
Serious side effects are less common but include severe hypotension, fainting (syncope), reflex tachycardia, and rarely methemoglobinemia at high doses. Tolerance can develop with continuous use, which is why patches are typically removed at night to allow a nitrate-free interval.
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Isosorbide Mononitrate (Imdur)
A long-acting nitrate taken once daily for angina prevention. Same drug class as Nitroglycerin.
Isosorbide Dinitrate (Isordil)
A shorter-acting nitrate for angina prevention and treatment, requiring multiple daily doses with a nitrate-free interval.
Ranolazine (Ranexa)
A non-nitrate anti-anginal medication that works by inhibiting late sodium current. Used when nitrates are insufficient or not tolerated.
Calcium Channel Blockers (Amlodipine, Diltiazem)
Alternative class for angina prevention that reduces oxygen demand and increases coronary blood flow.
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PDE5 inhibitors (Sildenafil/Viagra, Tadalafil/Cialis, Vardenafil/Levitra)
moderateCONTRAINDICATED. Can cause severe, potentially fatal hypotension. Do not take within 24–48 hours of each other.
Riociguat (Adempas)
moderateCONTRAINDICATED due to severe hypotension risk.
Alcohol
moderateSignificantly increases hypotension risk; can cause severe dizziness and fainting.
Other blood pressure medications
moderateAdditive blood pressure lowering with antihypertensives, beta-blockers, calcium channel blockers, and diuretics.
Ergot alkaloids
moderateMay antagonize Nitroglycerin's effects on coronary arteries.
Heparin
moderateNitroglycerin may reduce heparin's anticoagulant effect.
Nitroglycerin remains one of the most important medications in cardiovascular medicine — the go-to rescue drug for angina attacks. While sublingual tablets have experienced intermittent shortages since 2023, multiple formulations (patches, sprays, ointments) provide alternatives when one form is unavailable.
Generic Nitroglycerin is affordable, widely covered by insurance, and does not require prior authorization. If you're having trouble finding Nitroglycerin in stock at your pharmacy, try Medfinder to check availability nearby, or ask your pharmacist about switching formulations. Always keep your sublingual tablets or spray accessible for emergencies, and replace sublingual tablets regularly as they lose potency once the bottle is opened.
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