Can I take nitroglycerin (sublingual nitrate) for chest pain on an airplane?

Using Nitroglycerin for Chest Pain on an Airplane

Yes, if you have been prescribed nitroglycerin for chronic stable angina, you can take it for chest pain while on an airplane, but should follow a specific protocol and be prepared to request emergency landing if symptoms don't resolve after the first dose.

Protocol for Using Nitroglycerin on an Airplane

For Patients Previously Prescribed Nitroglycerin:

• Sit down before taking nitroglycerin to prevent falls due to potential dizziness 1
• Take ONE sublingual nitroglycerin tablet at the first sign of chest pain 2
• Wait 5 minutes to assess if chest pain improves 2
• If chest pain is unimproved or worsening after 5 minutes:
  • Alert flight attendants immediately
  • Request emergency medical assistance and possible emergency landing 2
• If symptoms significantly improve after the first dose:
  • You may repeat nitroglycerin every 5 minutes for a total of 3 doses 2
  • If symptoms have not completely resolved after 3 doses, medical assistance should be sought 2

Important Safety Considerations:

• Do not stand up immediately after taking nitroglycerin as this increases risk of dizziness and falls 3, 1
• Alert flight attendants about your condition even if symptoms improve after the first dose
• Do not take nitroglycerin if you've used medications for erectile dysfunction (sildenafil/Viagra within 24 hours, tadalafil/Cialis within 48 hours) as this can cause dangerous drops in blood pressure 3, 1
• Do not take nitroglycerin if your systolic blood pressure is below 90 mmHg 3

Special Considerations for Air Travel

• The reduced cabin pressure and oxygen levels in an airplane may exacerbate cardiac symptoms 4
• The limited medical resources available on an aircraft make prompt decision-making crucial
• Approximately 1 in 300 patients with chest pain transported by private vehicle experiences cardiac arrest en route 2 - this risk is magnified in the confined space of an aircraft

When to Request Emergency Landing

• If chest pain is severe and different from your typical angina 1
• If pain persists after a total of 3 tablets in a 15-minute period 1
• If you develop additional symptoms such as shortness of breath, nausea, lightheadedness, or sweating 3
• If you have any doubt about the nature of your symptoms

Common Pitfalls to Avoid

• Don't delay treatment - take nitroglycerin at the first sign of chest pain 2
• Don't attempt to "tough it out" - prompt treatment improves outcomes
• Don't consume alcohol before or after taking nitroglycerin as this can worsen hypotension 1
• Don't use someone else's nitroglycerin if you haven't been prescribed it yourself 2
• Don't swallow the tablet - it should dissolve under the tongue for proper absorption 1

Remember that chest pain on an airplane requires prompt attention. While nitroglycerin can provide relief for those with known stable angina, any persistent symptoms warrant immediate medical evaluation upon landing.