Has your doctor ever given you or someone in your family a little spray to use when you feel a pain in your heart? You may have been advised to spray it under your tongue when you feel chest tightness or pain. We usually call this the GTN spray. Although many people use it, they don't know exactly how to use it, what it can do, and what medications should not be taken with it. So, today we will talk about this very important GTN spray in a simple way that you can understand.
Simply put, what is this GTN spray (Nitroglycerin)?
This is a medicine that is given to control and prevent angina , a condition that occurs in the chest in an emergency. To be precise, it works by widening the blood vessels that supply blood to your heart and relaxing them. This makes it easier for blood to flow to the heart, and the workload on the heart is reduced. When the workload on the heart is reduced in this way, the chest pain also decreases quickly. This medicine belongs to a group of drugs called nitrates .
Things you need to tell your doctor before using this medicine
If you have any of these conditions, you should definitely inform your doctor before using this medicine.
- If you have any liver disease .
- If you have recently had a heart attack .
- If you have an allergic reaction to nitroglycerin, other medications, foods, or food dyes.
- If you are pregnant , trying to get pregnant , or breastfeeding .
This information is very important for your safety, so tell the doctor without hiding anything.
This is how to use this spray correctly:
This section is very important. Please read it carefully.
This spray is for oral use only. It should be used as soon as chest pain starts. It can also be used 5 to 10 minutes before doing something that you think might cause chest pain (e.g., climbing stairs).
The correct method to use:
1. Sit down: It is very important to sit down while taking this medicine, as sometimes you may feel dizzy.
2. Prepare: Remove the plastic cap from the top of the bottle. Do not shake the bottle.
3. First Use (Priming): If you are using this for the first time, you need to activate it. To do this, hold the bottle upright and spray it about 5 times in the air, away from you. Do not inhale it.
4. Reactivation: If you have not used this spray in about 6 weeks, you should spray it into the air once more before using it.
5. Spraying: Hold the bottle upright and spray either on or under your tongue.
6. After: Do not breathe in while spraying. Close your mouth after spraying, but do not swallow or rinse your mouth. Give the medicine some time to absorb.
What to do in an emergency (15 minute rule)
- You should feel relief within 5 minutes of taking the first dose.
- If you don't feel relief, you can take another dose in 5 minutes.
- This way, you can take up to a maximum of 3 doses every 5 minutes.
Very important: If you do not feel any better after taking the first dose, or if you feel that your condition is getting worse, go to a hospital emergency room (ETU) immediately or call the 1990 ambulance service. Never take more than 3 doses within 15 minutes.
What if I take too much medicine?
If you think you have taken too much of this medicine, go to the nearest hospital Emergency Department (ETU) immediately. Or call the National Poisons Information Centre at the Colombo National Hospital .
Medications that should not be taken with this spray
This is another life-saving tip. GTN spray can react with some medications and cause a dangerous drop in blood pressure.
| Drug category | Examples and descriptions |
|---|---|
| Medication for Erectile Dysfunction | Medications like Sildenafil, Tadalafil, Vardenafil (which may come under different names in the market) are extremely dangerous to take with GTN. |
| Some medications for migraines | Medications such as Ergotamine and Dihydroergotamine (DHE). |
| Riociguat | A special medicine for pulmonary hypertension. |
| Medication for high blood pressure | This can also have an effect on other blood pressure medications. |
It is very important to tell your doctor about all medications, vitamins, and herbal products you are taking. This can help prevent unnecessary risks.
When using GTN spray, be aware of these things:
- Always keep it with you: This spray is like your life-saving friend. So keep it with you at all times.
- Stay calm: Don't panic when you have chest pain, sit down, and take your medicine calmly. This will help you recover faster.
- Remedies for dizziness: If you feel dizzy, take a few deep breaths and lie down with your legs elevated. Or sit in a chair and rest your head between your knees.
- Tasks requiring attention: You may feel sleepy and dizzy. Therefore , do not do dangerous tasks such as driving or operating machinery until you know how this medicine affects you.
- Don't stand up suddenly: Especially if you are elderly, don't stand up or sit down suddenly. This will reduce the chance of fainting and falling.
- Alcohol: Taking this medication with alcohol may increase drowsiness and dizziness. Therefore , avoid alcohol completely.
- Other medications: Do not take over-the-counter cough, cold, or pain medications without first checking with your doctor. Some medications can increase your blood pressure.
Possible side effects of the medicine
| Type of side effect | Characteristics |
|---|---|
| Side effects that you should report to your doctor immediately | |
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Methemoglobinemia (a condition where oxygen levels in the blood are low) | Unusual headache, weakness, difficulty breathing, nausea, vomiting, rapid heartbeat, blue skin or lips. |
| Increased pressure around the brain | Severe headache, blurred vision, vision changes, nausea, vomiting. |
| Low blood pressure | Dizziness, fainting, blurred vision. |
| Slow heartbeat | Dizziness, fainting, confusion, difficulty breathing. |
| Increased chest pain (angina) | Increasing pain or tightness in the chest, neck, back, or arms. |
| Things to tell your doctor if they are usually not serious, but persist | |
| Headache | This is a very common side effect. |
| Dizziness | It occurs as soon as you take the medicine and subsides after a while. |
| Flushing | This is caused by increased blood supply to the skin. |
How do you store and keep the medicine?
- Keep it out of the reach of children .
- Store at room temperature (between 15 and 30 degrees Celsius).
- Do not spray near an open flame. Do not force open the bottle or throw it into a fire.
- Throw away after expiration.
Take-Home Message
- GTN spray is used for sudden chest pain (angina), not as a daily medication.
- Always sit down when taking the medicine. If the chest pain does not subside after the first dose or if it gets worse, go to the hospital immediately.
- Never take more than 3 doses within 15 minutes.
- It is extremely dangerous to use this with medications for sexual dysfunction (like Sildenafil).
- Tell your doctor about all the medications you take. If you have any questions, don't be afraid to ask your doctor.
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