When This Medicine Should Not Be Used:
This medicine is not right for everyone. Do not use it if you had an allergic reaction to nitroglycerin or similar medicines.

How to Use This Medicine:
Powder, Spray, Tablet

• Your doctor will tell you how much medicine to use. Do not use more than directed. Sit down before you take this medicine, because it could make you lightheaded.
• You may use this medicine 5 to 10 minutes before an activity that can cause angina. This may help prevent the attack.
• Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.
• Powder:
  
  • Empty the contents of a packet under your tongue. Close your mouth and breathe normally. Allow powder to dissolve without swallowing. Do not rinse or spit for 5 minutes after taking this medicine. Do not take more than 3 packets in 15 minutes. If you still have pain after you take a total of 3 packets, this is an emergency. Call 911. Do not drive yourself to the hospital.
  • Store the powder at room temperature, away from heat, moisture, and direct light.
• Tablets:
  
  • Wet the tablet with saliva and place it under your tongue or inside your cheek. Let the tablet dissolve. Do not chew, crush, or swallow the tablet. Wait 5 minutes. If you still have pain, take a second tablet. Do not take more than 3 tablets in 15 minutes. If you still have pain after you take a total of 3 tablets, this is an emergency. Call 911. Do not drive yourself to the hospital.
  • Store the tablets at room temperature in the original container, away from heat, moisture, and direct light.
• Spray:
  
  • To prime the spray before you use it for the first time:
    
    • Point the Nitrolingual® Pumpspray bottle away from your face. Pump the spray 5 times. The medicine is now ready to use.
      
      • If you do not use the medicine for 6 weeks, pump the spray 1 time to re-prime the bottle.
      • If you do not use the medicine for 3 months, pump the spray 5 times to re-prime the bottle.
    • Point the NitroMist® bottle away from your face. Pump the spray 10 times. The medicine is now ready to use.
      
      • If you do not use the medicine for 6 weeks, pump the spray 2 times to re-prime the bottle.
  
  
  • To use the spray:
    
    • Hold the bottle upright and close to your mouth. Open your mouth and spray the medicine onto or under your tongue. Close your mouth right away. Do not inhale the spray or get it in your eyes. Do not rinse your mouth for at least 5 to 10 minutes.
    • Wait 5 minutes. If you still have pain, use another spray. Do not use more than 3 sprays within 15 minutes.
    • If you still have pain after you use a total of 3 sprays, this is an emergency.Call 911. Do not drive yourself to the hospital.
  • Do not shake the bottle. Do not use the spray near heat, open flame, or while smoking.
  • Check the fluid level regularly according to the medicine directions. Refill your prescription before the level falls too low.
  • Store the spray in an upright position at room temperature, away from heat. Do not open or burn the spray container.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Do not use this medicine if you are also using avanafil, riociguat, sildenafil, tadalafil, or vardenafil.
• Some foods and medicines can affect how nitroglycerin works. Tell your doctor if you are using any of the following:
  
  • Alteplase, aspirin, heparin
  • Blood pressure medicines
  • Diuretic (water pill)
  • Ergot medicines
• Tell your doctor if you are using any medicine that makes your mouth dry, such as medicines that treat depression.

Warnings While Using This Medicine:

• Tell your doctor if you are pregnant or breastfeeding, or if you have kidney disease, anemia, low blood pressure, heart failure, heart disease, an enlarged heart, or a recent heart attack or stroke. Tell your doctor if you have a history of a head injury.
• This medicine may cause severe low blood pressure. This can make you dizzy or lightheaded. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. These symptoms may be worse if you drink alcohol.
• Medicine that treats chest pain sometimes causes headaches when you first start using it. This is normal. Do not stop using the medicine to avoid headaches. Ask your doctor if you can take aspirin or acetaminophen to treat the headache.
• Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blurred vision
• Increased chest pain, fast or slow heartbeat
• Severe or ongoing dizziness, lightheadedness, or fainting
• Throbbing, severe, or ongoing headache, confusion, low fever, vision problems
• Trouble breathing, cold sweat, blue skin, lips, or nails
• Warmth or redness in your face, neck, arms, or upper chest

If you notice these less serious side effects, talk with your doctor:

• Dry mouth
• Nausea or vomiting
• Numbness or tingling in your hands, ankles, or feet

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088