This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Glyceryl trinitrate oromucosal

Updated 2 Feb 2023 | Short acting nitrates


Metered dose spray of glyceryl trinitrate.

Drugs List

  • glyceryl trinitrate 400microgram aerosol sublingual spray
  • glyceryl trinitrate 400microgram pump sublingual spray
  • GLYTRIN 400microgram aerosol sublingual spray
  • NITROLINGUAL 400microgram pump sublingual spray
  • Therapeutic Indications


    Prinzmetal angina
    Prophylaxis of angina pectoris
    Treatment of angina pectoris



    Treatment of acute attack
    One or two 400microgram metered doses to be sprayed under the tongue while the breath is held on onset of attack.
    A maximum of three 400microgram metered doses can be given at any one time.

    Prophylaxis of angina pectoris
    One or two 400microgram metered doses sprayed under the tongue immediately prior to or within 2 to 3 minutes of the start of the event.


    For sublingual administration the bottle should be held vertically with the valve head uppermost. The spray orifice should be placed as close to the mouth as possible. The first dose should be sprayed under the tongue and the mouth should be closed immediately after each dose. The spray should not be inhaled. During application the patient should rest, ideally in the sitting position.


    Children under 18 years
    Systolic blood pressure < 90mmHg
    Aortic stenosis
    Cardiac tamponade
    Cardiogenic shock
    Cerebrovascular haemorrhage
    Circulatory failure
    Constrictive pericarditis
    G6PD deficiency
    Head trauma
    Hypertrophic obstructive cardiomyopathy
    Mitral stenosis
    Narrow angle glaucoma
    Raised intracranial pressure
    Severe anaemia
    Severe bradycardia
    Toxic pulmonary oedema

    Precautions and Warnings

    Low cardiac filling pressures
    Predisposition to narrow angle glaucoma
    Predisposition to orthostatic hypotension
    Cerebrovascular disorder
    Severe hepatic impairment
    Severe renal impairment

    Lack of effect may indicate early myocardial infarction
    Advise ability to drive/operate machinery may be affected by side effects
    Some formulations may contain alcohol
    Advise patient to seek medical help if symptoms unresolved after 3 doses
    Some preparations are flammable: Advise patient not to use near naked flame
    Monitor patients at risk of glaucoma for increases in intraocular pressure
    Cross tolerance to other nitrates may develop
    Hypotensive effects may be potentiated by alcohol

    Caution is advised when treating ambulant patients with the combination of angina and moderate to severe valvular aortic stenosis.

    Glyceryl trinitrate could compromise myocardial blood supply in patients with left ventricular hypertrophy associated with aortic stenosis because of the detrimental effects of tachycardia and decreased aortic diastolic pressure.

    Pregnancy and Lactation


    Use glyceryl trinitrate with caution in pregnancy.

    There is limited data available regarding the use of glyceryl trinitrate in pregnancy. Animal studies do not indicate harmful effects on pregnancy, embryofoetal development, parturition or postnatal development.

    Some manufacturers advise only administering glyceryl trinitrate if the expected benefit to the mother is greater than any possible risk to the foetus. Schaefer (2015) comments that nitrates may be used in pregnancy for appropriate indications.


    Use glyceryl trinitrate with caution in breastfeeding.

    It is not known if glyceryl trinitrate or its metabolites are excreted in human milk. Schaefer (2015) states that short term use is justifiable for relevant indications. The short half-life of the drug and temporary use suggest no toxic risk to the breastfeeding infant.

    Some manufacturers recommend making a decision whether to discontinue or abstain from breastfeeding or glyceryl trinitrate therapy, taking into account the benefit of breastfeeding for the child and the benefit of therapy for the woman.

    Side Effects

    Allergic skin reactions
    Cerebral ischaemia
    Circulatory collapse
    Decrease in blood pressure
    Exfoliative dermatitis
    Facial flushing
    Orthostatic hypotension
    Respiration worsening
    Taste disturbances
    Tolerance to this drug and cross tolerance to other nitrates
    Tongue blistering
    Transient hypoxaemia
    Worsening of angina


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: February 2019

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Summary of Product Characteristics: Glyceryl trinitrate spray 400mcg/metered dose, sublingual spray. Aspire Pharma Ltd. Revised June 2017.
    Summary of Product Characteristics: Glytrin 400 micrograms per metered dose. Aspire Pharma Ltd. Revised December 2017.
    Summary of Product Characteristics: Nitrolingual Pump Spray 400micrograms per dose. Intrapharm. Revised January 2018.
    Summary of Product Characteristics: Nitromin 400micrograms per actuation sublingual spray. EGIS pharmaceuticals uk Ltd. Revised November 2014.

    NICE Evidence Services Available at: Last accessed: 12 February 2019

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Nitroglycerin Last revised: 31 October 2018
    Last accessed: 12 February 2019

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.