How many times can I safely use Nitroglycerin a day.

I am a 38 year old male. Recently diagnosed with vasospastic angina. I was prescribed Nitroglycerin sublingal spray (and calcium channel blocker Diltiazem),
I was told that I should use the nitro whenever I get chest pain and to spray once wait 3 minutes if it doesn't work then spray again, if it doesn't work then call the doctor. (protocol was different last week when I was first prescribed tablet form).
The problem is, if I use it every time I have pain, I will be taking it at least 13-14 times a day!.
What I usually do is wait for about 5 minutes and if the pain gets worse or doesn't go away, take a shot.
Yesterday was a bad day and I used it very conservatively but needed to use it 4 times.
To be honest it doesn't really seem to always work and I am too scared to take the second shot in case that doesn't work either. So i try to "will"  away the pain or bear it until it goes.

My question is, how many times a day can I safely use it or at what point should I go to the hospital?  There are no guidelines other than if it doesn't work after 2 consecutive shots, go to the hospital.

Also if the nitro isn't working, is it really vasospastic angina?  I got a second opinion and that doctor conferred based on the test results of the first hospital.

[cindy707]

If it was my body and i was going thru what you are what i would do is go to the bottle...then go to the internet and link onto the manufacturers site and see what they have to say in regards to indicators, dosage, events, outcome and let that be the earmark for you.  Number one and foremost is that you need to follow the directions of your doc however you also need to stay fully informed on what the manufacturer recommends because the FDA has to approve dosage, usage, etc. before it can be given to the general public thru clinical trials.  Thats number one.  As far as your last paragraph goes.....if the second doc concurred with your doc i would question a couple of things...does that doc practice or share privliges and on call rotation w. your doc?  Because at times birds of a feather stick together...meaning that docs don;t like stepping on their associates toes...thats a given so hopefully it was an independent consultation.  My next question is if you are having such frequent episodes have the docs mentioned stenting to you as a cure for this situation which in most cases is pretty darned successful?  If the episodes are happening at rest then yep it points to VA....the bottom line is the bottom line..you need to follow your doctors orders to the T and not try to self diagnose or mix up his/her treatment plan but if it were my body i would do exactly what you are...questioning everything and then get proactive to try to get this taken care of it possible...good luck and look up that manu. site.....it'll open up a whole new world to you believe me.....

[HRA]

Thank you so much for your quick reply.　I had actually looked at the manufacturer's site first (as I do with any medicine) and they basically say to follow the doctors instructions.
The problem is when the doctor won't give any clear guidelines. I really get the feeling that he doesn't really take my case seriously as he has far more serious patients to deal with (a busy, highly regarded surgeon).

Actually he had first made the diagnosis of VA without even examining me! I went to the hospital with chest pains (at rest) they took an ECG which by the time they took it was normal (attack had just finished when they finally got me hooked up). His attitude seemed to be well you're young so it can't be anything else. At least that is how I felt.

I told him that I had familial Hypercholesterolemia, and that I had recently lost a lot of weight through diet and exercise, so he decided to run more tests.I guess until then he assumed by just looking at my body, I must be healthy (I have an athletic build).

He did blood enzyme tests ( which he forgot to tell me the results of, must ask) Echocardiagram (normal) EKG (normal) and a Coronary CT Angiography (CTA) which showed no abnormalities.  He said there was no need for more invasive investigation.

He prescribed 5 nitro tablets and Benidipine (a popular CCB for VA here). But I had to go back again and he prescribed more nitro tablets. The third time I went he changed the tablets to spray as I needed it at least 3 times a day and changed the CCB to Diltiazem.

He said that I was too stressed and need to relax, and go back to exercising regularly (which I did until this thing started). Stressed! I have never been so stressed in my life since being told I have VA!  and not trusting him entirely doesn't help. He seems to not take it so seriously (I guess its not him who has to go through the pain or put his life on hold while he figures out what the *** is happening to him!)

The doctor I got the second opinion from is not connected to his hospital but knows him and respects him a lot (he is junior to him). He is an ex-student of mine.

The problem with a lot of doctors here is that if you get proactive, they take offence. The higher their "star" status is, the more arrogant they become.

Regarding the stent, funnily enough the doctor is one of the leading stent surgeons and travels around the world to do operations. He has not suggested it yet or even discussed the option.

[cindy707]

I again am sorry you are going thru this...it is unnecessary and ridiculous and those are terrible bedside manners you are dealing w.  Number one is that i think its safe to say that you can discount the second opinion because just as i figured they are associates.  I can only give you a personal opinion on this but i have to be honest in saying that if it were me i would run and not walk in finding another doc.  There are just way too many red flags with this guy....his patient load is obviously over extended and you are just being tossed into the mix w. how many other patients.  You deserve to have personal care and be treated as an individual that indeed is important and if he can't make time then move on.  There is nothing that is locking you into this doc....if a doc takes offense because you care about your health and want to sustain your own life that is what we all call the God complex and God help us all the crosses them...but the bottom line is that its your body, your choice, your life.  I have one of the best cardiac surgeons in the world today and you could ask him to come to your house for a BBQ on Sunday and he would ask you what time should he be there and could be bring a date.......in this day and age of medical science and the competetiveness out there they ought to know better...word gets out.  Start researching if you can because you are either going to have to pin this guy down and tell his secretary that you want a sit down consult with him for 20 minutes to clear some things up or you are going to have to find a doc that cares and will take the time with you.  Like my grandpa used to say...you can't be walked on unless you lay down first........good luck and i hope you do this for you so you can get back to the life of the living and put this behind you with a confirmed and difinitive diagnosis and shame on him is all i gotta say.....................

[HRA]

Thank you again for taking time to reply.

I am off to see another cardiologist at another hospital tomorrow a.m.

I'm thinking of contacting a neurologist as well. The pain in my chest feels like it  could be chest wall muscle spasms or something else. I don't get radiating pain common in angina and nitro doesn't help. it feels pretty close to a chest sprain at times. (I was doing quite a bit of training prior to when this all started and my chest is sore when I press).

[txcourtreporter]

I am 35 and had a quintuple bypass and continue to have pain down my left arm and chest pain a lot.  If I took nitro every time I had pain I too would take a table four to eight times a day.  Is this safe?  Everyone says to take it because it's bad to let your heart work too hard.  Can your body ever get "immune" to the nitro and it not work?

[greenlydia]

I sincerely believe the ONLY person who should be answering your questions and advising you on your med dosage and/or frequency is your cardiologist. PERIOD.

Does it really matter what MY opinion is? Or what dose I'm on or how often I take it?

There is no "one size fits all" when it comes to our heart conditions. You must follow what YOUR doctor tells you to do for YOUR condition.

And who, exactly, is this "everyone" you speak of who is telling you take it? If it's a car load of cardiologists, then I'd say go ahead and take it. If not, then get it from the horses mouth and no one elses!

This is your HEART, not a hangnail.
Peace
Greenlydia