• Storage of nitrate tablets that dissolve under the tongue (sublingual tablets) differs from other medications because the potency of this medication is diminished when exposed to air, moisture or warmth. The pills come in a dark brown bottle with a piece of cotton inside. Patients should remove and discard the cotton from the bottle (and not replace it after each use) because it deactivates the nitrates. It is vital that the medication not be transferred to another container because the original brown container protects the medication from sunlight.

  • Nitrates can deteriorate. When taking tablets or pills, patients should carefully close the bottle after each use to minimize air exposure and frequently replace any pills they carry with them. Patients should avoid carrying the medication close to their skin, which produces heat and makes the medication deteriorate faster. In addition, when taking medications out of the bottle, patients should not place several in the palm of their hand, choose one and then replace others in the bottle. Even this brief contact with the heat of the skin could change the potency of the pills. Instead, it is recommended that the patient pour the pills into the top of the bottle, take one and replace the others. Nitrates should be stored in a cool, dry place. Once opened, nitrate medications will be good for only three to six months.

  • Extended-release nitrates are more stable and therefore do not lose their potency as quickly. Patients taking time-release tablets or capsules may notice partially dissolved medications in their stools. Physicians should be notified if this occurs because the pills must be completely digested for the medication to be effective.

  • Patients using nitrates in an oral spray should be careful never to shake the container or inhale the spray. The medication in the spray is intended to be absorbed into the bloodstream through the mouth. Therefore, patients should refrain from swallowing immediately after spraying the medication. When absorbed through the stomach, nitrates will take longer to affect body functions. This is also true for the chewable tablets, which should be chewed for two minutes before swallowing.

  • Topical ointments (or lotions) should be placed on the skin, but not rubbed or massaged into the skin. Patients should be careful to remove any remaining ointment from the skin before applying a new dose and to always place the ointment over the same area of skin with each application. Patients using skin patches should use the entire patch. Trimming or cutting the patch can expose the active ingredients to air, causing deterioration.