Correcting the Misconception: Nitrostat vs. Nitroglycerin Ointment
Before delving into its uses, it is crucial to clarify a common point of confusion. The brand name Nitrostat specifically refers to sublingual nitroglycerin tablets, which are used to treat an active episode of chest pain. The topical medication, an ointment, is typically known by its generic name, nitroglycerin ointment, or by other brand names such as Nitro-Bid or Rectiv, depending on its specific use. This article will focus on the uses of the topical nitroglycerin ointment.
Uses of Nitroglycerin Ointment
Nitroglycerin ointment belongs to a class of medications called nitrates and functions as a vasodilator, meaning it relaxes and widens blood vessels. The absorption of the medication through the skin provides a slower, more prolonged effect than the sublingual tablets. As a result, its primary applications are preventative and long-term rather than for immediate relief.
Preventing Angina (Chest Pain)
For individuals with coronary artery disease (CAD), the narrowing of blood vessels can lead to episodes of chest pain, known as angina. The ointment is used to help prevent these attacks by reducing the heart's workload and increasing blood flow. When applied regularly, it ensures a continuous supply of nitroglycerin to the bloodstream. It is important to remember that this ointment is not a rescue medication and will not work fast enough to stop an attack once it has started. For acute attacks, faster-acting options, like sublingual tablets or spray, are necessary.
Treating Anal Fissures
Another distinct use for nitroglycerin ointment is the treatment of pain caused by chronic anal fissures, which are small tears or splits in the lining of the anus. Applied directly to the affected area, the ointment relaxes the muscles and blood vessels, which reduces pressure inside the anus and promotes healing. The application method for this condition is different than for angina prevention and involves a gloved finger.
How to Properly Apply Nitroglycerin Ointment
Proper application is essential for the medication to be effective and to prevent accidental exposure to others. Instructions will vary slightly depending on the condition being treated.
For angina prevention:
- Measure the dose: Use the special ruled measuring paper that comes with the medication to accurately measure the prescribed amount.
- Choose a site: Select a clean, dry, hairless area of skin, typically on the chest, back, or upper arm.
- Apply and spread: Place the ointment on the measuring paper, then place the paper (ointment-side down) on the skin and spread it lightly into a thin layer. Do not rub the ointment in.
- Cover the area: Secure the paper in place with tape and cover it with a piece of plastic kitchen wrap to prevent staining clothing.
- Wash your hands: Always wash your hands thoroughly after applying the ointment to avoid transferring it to other people or surfaces.
For anal fissure treatment:
- Use protection: Cover your finger with a disposable glove, finger cot, or plastic wrap.
- Measure the dose: Squeeze the prescribed amount onto your covered finger, using the dosing line on the medication box as a guide.
- Apply gently: Insert the finger into the anal canal up to the first joint and smear the ointment around the inside. If this is too painful, apply it to the outside of the anus instead.
- Dispose and wash: Dispose of the finger covering properly and wash your hands thoroughly.
Potential Side Effects and Precautions
As with any medication, nitroglycerin ointment can cause side effects. Some are more common and manageable, while others can be serious.
- Headaches: This is a very common side effect and can be a sign that the medication is working. Over-the-counter pain relievers may be an option, but consult your doctor first.
- Dizziness and lightheadedness: This can occur, especially when moving from a sitting or lying position to standing. It is important to move slowly to avoid fainting.
- Skin irritation: Redness, burning, or a rash can occur at the application site. Rotating the application site daily can help.
- Flushing: A warm, flushed feeling is possible.
- Low blood pressure: Nitroglycerin lowers blood pressure, and this effect can be worsened by alcohol.
Precautions include not stopping the medication suddenly and avoiding alcohol while using it. It is also contraindicated for people taking certain erectile dysfunction medications, which can lead to a dangerous drop in blood pressure.
Nitroglycerin Ointment vs. Sublingual Tablets
Choosing the right formulation of nitroglycerin depends on the intended purpose. The table below outlines the key differences between the ointment and sublingual tablets.
| Feature | Nitroglycerin Ointment (e.g., Nitro-Bid) | Sublingual Nitroglycerin (e.g., Nitrostat) |
|---|---|---|
| Primary Purpose | Long-term prevention of angina episodes and treatment of anal fissure pain. | Treatment of an acute angina attack (fast-acting). |
| Onset of Action | Slower; takes around 30-60 minutes to start working and reach steady blood levels. | Rapid; works within 5 minutes for immediate relief of chest pain. |
| Duration of Effect | Long-lasting; effects can persist for several hours, typically used twice daily with a nitrate-free period. | Short-acting; effects are brief and meant for immediate, temporary relief. |
| Application Method | Applied topically to the skin using a measuring paper for angina or a finger for anal fissures. | Placed under the tongue to dissolve. |
Conclusion
Nitroglycerin ointment is a valuable medication with specific applications for long-term symptom management. While often confused with the brand-name tablet Nitrostat, the ointment serves distinct purposes, primarily the prevention of angina and the relief of pain from anal fissures. Its slower, sustained effect makes it unsuitable for acute medical emergencies. Proper application, following the specific instructions from a healthcare provider, is critical for safety and efficacy. Patients should also be aware of potential side effects, such as headaches and dizziness, and take appropriate precautions. For additional information on this and other medications, consult a reliable source such as the MedlinePlus Drug Information.
