Nitrosol Spray

Nitrosol Spray is a fast-acting sublingual (under-the-tongue) spray containing nitroglycerin, also known as glyceryl trinitrate (GTN), used for the rapid relief of acute angina attacks – the chest pain or tightness that occurs when the heart muscle temporarily does not receive enough oxygen-rich blood. It is not a nasal decongestant and is not used for a blocked nose, sinus congestion, or a stuffy nose; it is a cardiac medicine sprayed onto or under the tongue, where it is rapidly absorbed into the bloodstream. Nitrosol Spray is a prescription-only medicine in Malaysia and Singapore and is dispensed only after a doctor has diagnosed angina or coronary artery disease and determined that this medicine is appropriate, typically through an in-person or online consultation with a doctor before dispensing.

Because it works within minutes to relax and widen blood vessels, Nitrosol Spray is usually prescribed for use at the onset of angina symptoms or just before activities known to trigger them, and forms part of an overall heart disease management plan directed by a cardiologist or treating doctor. Chest pain that does not settle after using this spray as directed, or chest pain that feels different, more severe, or is accompanied by other warning symptoms, is a medical emergency and requires immediate emergency medical attention – it should never be self-diagnosed or managed solely with this product.

Nitroglycerin is converted in the body into nitric oxide, which relaxes the smooth muscle in blood vessel walls, causing veins and, to a lesser extent, arteries to widen (vasodilation). This reduces the amount of work the heart has to do and improves blood flow to the heart muscle, quickly easing the chest pain caused by an acute angina episode.

Nitrosol Spray should only be used exactly as directed by the prescribing doctor. At the onset of angina symptoms, the person typically sits down, and one or two sprays are released onto or under the tongue without inhaling, avoiding swallowing immediately afterward so the medicine can be absorbed through the mouth lining. If chest pain does not ease within the time period specified by the doctor (commonly around 5 minutes) after the first dose, and after a second dose if directed, emergency medical help should be sought immediately, as this may indicate a heart attack rather than a typical angina episode.

The usual prescribed dose is one to two sprays under the tongue at the onset of chest pain, which may be repeated after a few minutes if symptoms persist, up to the maximum number of sprays or doses set by the prescribing doctor. Dosage and repeat-use instructions must follow the individual doctor’s directions precisely, as this is a potent cardiovascular medicine, and it should not be used more frequently or in higher amounts than prescribed.

Nitrosol Spray typically has a shelf life of around 2 to 3 years from the date of manufacture when unopened; always check the expiry date on the canister and carton, as nitroglycerin products can lose potency over time. Do not use the spray after its expiry date, since a weakened dose may fail to relieve an angina attack effectively.

Store Nitrosol Spray below 30°C, away from heat, direct sunlight, and naked flames, as it is contained in a pressurised canister. Keep the canister upright and tightly capped between uses, out of reach and sight of children, and carry it with you at all times if you have been prescribed it for angina relief, so it is available when needed.

• Known hypersensitivity to nitroglycerin or other nitrates
• Use of phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil, tadalafil, or vardenafil (e.g. for erectile dysfunction) within the timeframe specified by a doctor, due to the risk of severe, dangerous drops in blood pressure
• Severe anaemia
• Raised intracranial pressure or recent head injury
• Severe low blood pressure or uncorrected low blood volume
• Hypertrophic obstructive cardiomyopathy or certain other specific heart conditions, unless specifically directed by a cardiologist

• PDE5 inhibitors (sildenafil, tadalafil, vardenafil) – must never be combined due to risk of severe hypotension
• Other blood pressure-lowering medicines, which may add to the blood-pressure-lowering effect
• Alcohol, which can worsen dizziness and low blood pressure
• Other vasodilators or nitrate-containing medicines

• Sit down before using the spray, as dizziness or fainting can occur
• Always carry your prescribed spray with you if you have been diagnosed with angina
• Follow your doctor’s specific instructions on how many sprays to use and when to seek emergency help
• Never combine this medicine with erectile dysfunction medicines without your doctor’s explicit guidance
• Chest pain that does not improve as expected, or that feels different or more severe, needs emergency medical attention – call for emergency help rather than waiting
• Keep track of your canister’s expiry date, as an expired spray may not work effectively during an attack

Nitrosol Spray is a cardiac emergency-relief medicine for people who have already been diagnosed with angina by a doctor; it is not intended for people to try on their own to determine whether chest discomfort is heart-related. Anyone experiencing new, severe, or worsening chest pain should seek emergency medical care immediately rather than relying on this or any medicine to self-manage the situation. Ongoing use of Nitrosol Spray should be reviewed regularly with the prescribing doctor as part of a broader coronary artery disease treatment plan.