Indications for NITROMIST:

Acute attacks and prophylaxis of angina.


1–2 sprays at onset of attack, on or under tongue while sitting; may repeat every 5 minutes as needed; max 3 sprays/15 minutes. May use prophylactically 5–10 minutes before exertion. Do not inhale spray. Do not rinse mouth for 5–10 minutes after use.


Not established.


Concomitant PDE5 inhibitors (eg, sildenafil, vardenafil, tadalafil), riociguat. Severe anemia. Increased intracranial pressure.


Volume depletion. Hypotension. Acute MI. CHF. Hypertrophic cardiomyopathy. Monitor for tolerance. Product is flammable. Elderly. Pregnancy (Cat.C). Nursing mothers.

Pharmacologic Class:



See Contraindications. Hypotension potentiated with PDE5 inhibitors, riociguat, antihypertensives, β-blockers, calcium channel blockers, alcohol. May be potentiated by aspirin. Nitroglycerin (IV) may antagonize t-PA, heparin (monitor APTT). Avoid concomitant ergotamine and related drugs. Do not use epinephrine to treat hypotension from nitrate overdose.

Adverse Reactions:

Headache (may be severe), flushing, rash, hypotension, syncope.

How Supplied:

Bottles—4.1g (90 metered sprays), 8.5g (230 metered sprays)