[dllfo]

Walgreen's head pharmacist said he never heard of it. My cardiologist and his office keep trying to send me Nitro pills.

IF YOU HAVE DRY MOUTH, AS MANY PEOPLE DO, GET THE NITRO SPRAY. It will keep you alive. I was revived by the EMT and I had 3 Nitro Pills under my tongue. He sprayed me with LIQUID NITRO (NitroLingual) and I started coming around.

I use Oasis spray (OTC) for my dry mouth. "Nitronitrolingual (nitroglycerin) spray
[FIRST HORIZON PHARMACEUTICAL CORPORATION] Nitrolingual® Pumpspray (nitroglycerin lingual spray) 400 mcg per spray, 60 or 200 Metered Sprays " I think there are several brands of this Nitro Spray, I just happened to use Nitrolingual for a few years.

It may save a life. I use it for my Angina attacks. I am amazed more people don't know about it. Hot summer day, mowing the lawn, you are thirsty (dry mouth perhaps?) and a heart attack hits (angina attack) and what good is one more tablet that won't dissolve in your mouth?

Sorry, rant over. If someone you know uses Nitro Pills/tablets, please make them aware of the difference.

[mrsD]

There are two listed in the FDA Orange Book reference.

Nitromist by Novadel

NitroMist™

NitroMist™ (nitroglycerin lingual aerosol) was approved by the U.S. Food & Drug Administration (FDA) in November 2006 for acute relief of an attack or acute prophylaxis of angina pectoris due to coronary artery disease. NovaDel is currently finalizing commercialization plans for this important drug.

and

Nitrolingual by Pohl Boskamp

This product used to be made by Rorer (which merged with another company a while back)

Obviously your pharmacist is not OLD. We oldsters remember the Rorer product.

If drug companies do not send in sales reps to the doctors, the doctors never realize that something exists and is available.
(some teaching hospitals may be the exception of this).
But most remain clueless. If doctors don't write for it, pharmacists don't see it and therefore don't know about it either.

The spray has never been a huge seller. I would see it only very occasionally in my 40 yrs + ...
The delivery device is critical for this drug, since such tiny amounts are delivered with each dose. I suspect the device is the hold up in production and dissemination of this product. Not the usefulness in the long run and the major cost factor too.

I don't know if all insurances pay for it. It may be not allowed due to cost. But with the shortage of nitro due to the Ethex recall (most nitro was supplied by Ethex), some people may be forced to use the spray--- and the insurances may override it for a short time.

It was never really popular for decades.

[dllfo]

mrsD,
Thanks for the background info. I may just print out some WebMD info and fax it to my Cardiologist's office. He is rated as one of the top five Cardiologists in the greater Sacramento area.

Since I put it in writing and TOLD HIM I can't use tablets due to dry mouth, and since I wrote it down in size 20 font, bold print, I am dumbfounded that he did not prescribe the right thing.
He IS a good doctor, except for this.

Oh well, maybe on the third day of trying we can get it right. Wish you were my pharmacist,
I think you know more about these things than my doctors.

[mrsD]

Thanks.... at least my mind is still pretty good. All those years and stresses....So I can at least share something yet, with people here. (the body is another story, as today is a Lidoderm day for ME).

You know back in the old days, we didn't have computers, or even patient profiles, etc. We had to REMEMBER everything. So I got into that habit when I was younger. I did have to look up the spray, since the parent drug company is no longer in existence. I was surprised to see TWO makers of the spray now.
Not sure about local availability thru your warehouses, but I would think they are having a windfall of sorts with the Nitroquick recalls by Ethex. I have received emails from Pfizer explaining how they had to gear up the brand name Nitrostat to cover this shortage.

Today, everything is computerized. No need to remember much since with a push of the button you can bring up the internet.
Instead pharmacists today fill their minds with pickyune details of all the drat insurances, and spend precious time with that instead of helping the patients and catching errors and omissions the doctors make.

Glad to be of help.

[Koala77]

I read with interest how Nitrolingual spray is not a commonly prescribed medication in the USA, because it's very popular here in Australia.

Most patients with a history of angina wear a Nitro patch, and carry a spray in case they have an episode of chest pain. The spray took over from Anginine tablets some years back.

Seeing that the Nitro sprays aren't used much in the USA, and out of interest only, could you please tell me what medication is ordered in your country for angina?

[mrsD]

Here in USA it is sublingual oral tablets for most people.

Severe cases get the patches. We also have an ointment, but that requires measuring, so it may be used more often in nursing homes.

In USA there has been a recall of all Ethex products and they had about 80-90% of the market. So the brand name is being used more (by Pfizer---called Nitrostat).

We also have long acting nitro type oral drugs. Nitroglycerin sustained capsules and synthetic types called Imdur (isosorbide mononitrate). These latter are used more than the older nitro caps. Imdur is also used to just improve vasodilation for cerebral vessels or other uses like blood pressure treatment (usually an add-on type drug).

Because USA is aggressive with bypass surgeries and stents, nitro products are not huge sellers here. Hence the spray would even be less common. People who cannot have surgery-- are risks-- or have no insurance would get the drugs, as opposed to insured patients who would get the stents/bypass.

I think there are cultural differences.

[Koala77]

Thank you for that mrsD. They do a lot of ballooning, bypassing (CABG) and insertion of stents here too, infact many of the smaller hospital here are upgrading to add Cardiac Cath labs to their list of services.

Isorbide tablets (Imdur and Isordil) and Diltiazen (plus others) are used here as well, but the patches are worn by a large percentage of sufferers.

The sublingual tablets (Anginine) are still around, but certainly not used as much as the sprays. As for the Nitro cream, I don't think I've seen that used since the late 70's or early 80's.


My apologies dllfo. As I was interested in this topic, I hope you'll forgive my intrusion.

[dllfo]

Koala77, no problem. I enjoyed hearing what you have to say.

They told me I am not a candidate for any procedures until they determine why I quit breathing. CCHS (I was born with it) is the only answer. Also, opiates make it worse. That may be why they decided to give me the Nitrolingual. That and my history of dry mouth. I bought a large quantity of "Oasis" at the drug store, it has helped a LOT.

I fear mrsD is correct, the new pharmacists are computer and insurance technicians, not like the old days. One of their pharmacists told me he knew what it was, but the young supervisor did not ask him. He only heard about the confusion the next day.

One other thing for everyone to watch out for is the "Best used by date" (USA anyway). I have received NitroLingual that was best used by ..... next month. I refuse those. I told Walgreens to get me a bottle with at least a year left on it. It goes "bad" in Mar 2010. I have used them for a few months after the suggested replacement date. Someone told me a drug is still at least 90% of full strength on the "replacement date".

The U.S. Military has taken a hard look at these "replacement dates" and test the meds on that date. How they test the medications was complicated while I was watching it, let alone months later, but suffice to say, they feel they can test it and have confidence in the results. Some of their stockpiles of medications are well past the "replacement Date" and are still good.

Thanks again for the help mrsD ......Dave

[mrsD]

Originally Posted by dllfo

Koala77, no problem. I enjoyed hearing what you have to say.

They told me I am not a candidate for any procedures until they determine why I quit breathing. CCHS (I was born with it) is the only answer. Also, opiates make it worse. That may be why they decided to give me the Nitrolingual. That and my history of dry mouth. I bought a large quantity of "Oasis" at the drug store, it has helped a LOT.

I fear mrsD is correct, the new pharmacists are computer and insurance technicians, not like the old days. One of their pharmacists told me he knew what it was, but the young supervisor did not ask him. He only heard about the confusion the next day.

One other thing for everyone to watch out for is the "Best used by date" (USA anyway). I have received NitroLingual that was best used by ..... next month. I refuse those. I told Walgreens to get me a bottle with at least a year left on it. It goes "bad" in Mar 2010. I have used them for a few months after the suggested replacement date. Someone told me a drug is still at least 90% of full strength on the "replacement date".

The U.S. Military has taken a hard look at these "replacement dates" and test the meds on that date. How they test the medications was complicated while I was watching it, let alone months later, but suffice to say, they feel they can test it and have confidence in the results. Some of their stockpiles of medications are well past the "replacement Date" and are still good.

Thanks again for the help mrsD ......Dave

While it is true that some drugs are still good past replacement dates...nitroglycerin is VERY unstable, and goes quickly.
The sublinguals are not stable for long once opened, (6mos I believe) and the spray may leak as well. Nitroglycerin outgasses...so it gets subpotent pretty quickly. This is why the little bottles of 25 are better, and always in GLASS.
The spray is a very sophisticated delivery device. Any tiny leak and it will outgas.

Tetracycline can kill you if outdated. It destroys the kidneys!

[dllfo]

mrsD, you help people in ways you may not be aware of. After reading your post about Nitro deteriorating quickly, I had a conversation with a lady at my insurance office this morning, she said she had to hurry, and apologized, but her nitro pills had expired in Aug 2008 and did not seem to be doing the job, therefore she had an appt with her Cardiologist this morning.

I told her what you said about some Nitro products deteriorating and she thanked me, saying she would be sure to remember that. I told her about the spray and its benefits. She said she did clench her teeth in pain, so she thought the spray might work best.

I told her anyone could pull her lip back and spray her gums if necessary. She likes that concept.

Thanks again for being here for us...Dave