Nitrolingual Spray 180 Dose

Always take this medicine exactly as described in the leaflet or as your doctor, pharmacist or nurse has told you. Check with your doctor, pharmacist or nurse if you are not sure. The spray is meant for use under your tongue and is not meant to be inhaled.

It is recommended to spray one or two puffs under your tongue. If symptoms do not resolve, you can repeat this at 5 minute intervals for a maximum of three puffs. If, after that, your symptoms have still not resolved, please seek immediate medical attention. The spray should work quickly and last about half an hour.

Before you use a new bottle of Nitrolingual, spray the first puff into the air to get the pump working properly. You
must also do this if you have not used the pump for a week or more. Get used to the feel of the grooved button in
case you need to use the pump in the dark.

• Rest or sit quietly, as you may feel faint or dizzy otherwise, particularly if you are elderly.
• Hold the bottle upright with your finger on the button. You don't need to shake the bottle.
• Open your mouth and put the bottle next to your chin.
• Press the button firmly so that the puff of medicine goes under your tongue. Close your mouth.
• Do not breathe in while you are taking the puff of medicine.

Keep the spray with you at all times. Through the side of the bottle you can see how much spray you have left. Make sure that you get a new spray before the old one runs out. Always keep a spare.

• Active Ingredient: Each puff of spray contains 400 micrograms of GTN.
• Other Ingredients: Medium-chain triglycerides, ethanol (absolute), glycerol monocaprylocaprate, peppermint oil, sodium (S)-lactate and (S)-lactic acid.

• If you use Nitrolingual very often or if you regularly use other nitrates, the pain relief you receive may be less.
• During use with dihydroergotamine (DHE) (used to treat migraines), Nitrolingual® may lead to an increase in
• DHE levels, thereby increasing blood pressure.
• If you drink alcohol before using Nitrolingual, you may feel dizzy or faint due to low blood pressure.
• Tell your doctor if you become pregnant while you are taking Nitrolingual. You should use Nitrolingual only after discussing with your doctor the potential benefits to you versus any potential risks to your unborn child. It is not known whether glyceryl trinitrate passes into human breast milk. You should ask your doctor for advice if you are breastfeeding. There is no sign of a harmful effect with respect to fertility.
• You should wait at least five minutes after using the spray before driving or using machinery. If you feel faint, dizzy or unwell, wait until you feel better. You should be particularly careful if you have just started using Nitrolingual, if you have changed your dosage or if you drink alcohol.
• Nitrolingual contains  small amounts of ethanol (alcohol); less than 10 mg per metered dose (puff).

Do not take Nitrolingual Spray:

• If you are allergic (hypersensitive) to nitrates or any of the other ingredients of Nitrolingual. An allergic reaction may include rash, itching, difficulty breathing or swelling of the face, lips, throat or tongue.
• If you are very ill because of very low blood pressure, severe blood loss, acute stroke, bleeding in the brain, a severe head injury or severe anaemia.
• If you have certain unusual heart conditions (such as acute circulatory shock (where there is insufficient blood flow reaching the body’s tissues), this can include hypovolaemic shock (as a result of low blood volume) and uncontrolled cardiogenic shock (as a result of decreased output from the heart), severe mitral stenosis (a narrowing of the opening to the heart mitral valve) or obstructive cardiomyopathy (a disease of the heart muscle causing obstruction of blood flow)), which your doctor will have told you about.
• If you are taking Viagra (sildenafil) or similar products (e.g., vardenafil, tadalafil) for the treatment of erectile dysfunction or hypertension of arterial lung vessels. If you take these products and Nitrolingual, a severe and possibly dangerous fall in blood pressure can occur. This would result in collapse, unconsciousness and could be fatal.

Talk to your doctor, pharmacist or nurse before taking Nitrolingual Spray:

• If you are in the early stages of an eye condition called glaucoma (where there is raised pressure within the eye).
• While taking Nitrolingual, tell your doctor if the spray does not stop the pain; or if the spray usually works, but this time the pain lasts longer (half an hour or more), or feels different or worse than usual.
• If you have aortic and/or mitral stenosis (a narrowing of the opening to the heart aortic or mitral valve).
• If you feel dizzy when you sit or stand upright suddenly.
• If you have cerebrovascular disease (brain disorders relating to disease of the blood vessels supplying the brain).
• If you have pericardial tamponade (compression of the heart caused by blood or fluid accumulation in the space between the heart muscle and the outer covering of the heart).
• If you have constrictive pericarditis (inflammation and swelling of the covering of the heart).
• If you have low blood oxygen in lung disease or pulmonary heart disease (enlargement of the right ventricle of the heart).
• If you have had a heart attack.
• If you have left ventricular hypertrophy (thickening of the muscle of the left ventricle of the heart) associated with aortic stenosis (narrowing of the opening of the aortic heart valve).
• If you have moderate to severe valvular aortic stenosis (narrowing of the opening of the aortic heart valve).

Tell your doctor or pharmacist if you are taking or have recently taken or might take any other medicines. This is important as using more than one medicine at the same time can strengthen or weaken the effect of the medicines. Your doctor may need to take special care or change the dose. This is especially important for:

• Medicines for the treatment of erectile dysfunction or hypertension of arterial lung vessels.
• Other medicines which can lower blood pressure, such as beta-blockers, calcium channel blockers and neuroleptics, vasodilators, anti-hypertensives, diuretics, tricyclic antidepressants, sapropterin.
• Anti-blood-clotting drugs such as heparin.
• N-acetyl-cysteine.