Can I use nitroglycerin (NTG) for a panic attack on a plane?

Nitroglycerin Should Not Be Used for Panic Attacks on an Airplane

Nitroglycerin is not indicated for panic attacks and should not be used for this purpose during air travel or in any other setting. 1, 2 Nitroglycerin is specifically indicated for the treatment of cardiac conditions such as acute coronary syndromes and angina, not for anxiety-related symptoms.

Why Nitroglycerin is Inappropriate for Panic Attacks

Mechanism and Indications

• Nitroglycerin works through direct vasodilation of both venous and arterial smooth muscle 2
• It is specifically indicated for:
  • Relief of ischemic chest pain in acute coronary syndromes 1
  • Management of angina pectoris 1, 2
  • Treatment of pulmonary congestion in heart failure 2

Risks of Inappropriate Use

• Significant hemodynamic effects:
  • Mean drop in systolic blood pressure of 14 mmHg after one dose 3
  • Risk of profound hypotension, especially at altitude where cabin pressure is lower 3, 4
• Potential serious adverse effects (1.3% of patients) including:
  • Profound bradycardia with hypotension
  • Syncope
  • Asystole (rare but reported) 3
• Side effects particularly problematic in an airplane:
  • Dizziness and lightheadedness 2
  • Headache
  • Risk of falls if standing after administration 2

Appropriate Management for Panic Attacks During Air Travel

First-Line Approaches

• Deep breathing exercises and grounding techniques
• Reassurance and calm communication
• Staying seated and focusing on slow, controlled breathing
• Sipping water

Medical Considerations

• If medication is needed for severe anxiety:
  • Anxiolytics may be appropriate but are not typically available in aircraft medical kits 5
  • While anxiolytics may alleviate apprehension and anxiety, there is no evidence they improve cardiac outcomes 1

Important Cautions About Nitroglycerin

Contraindications

• Hypotension (SBP <90 mmHg or ≥30 mmHg below baseline) 2
• Recent use of phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil) 1, 2
• Right ventricular infarction 2

Aircraft Considerations

• Commercial aircraft medical kits do contain nitroglycerin, but it is intended for cardiac emergencies 5
• The reduced cabin pressure at altitude may exacerbate the hypotensive effects of nitroglycerin
• Limited medical monitoring capabilities during flight increase risks

Conclusion

Nitroglycerin is a potent medication specifically designed for cardiac conditions that causes significant hemodynamic changes. Using it for panic attacks is inappropriate, potentially dangerous, and diverts a critical medication from its intended use. If you experience panic attacks during air travel, discuss appropriate preventive strategies and medications with your healthcare provider before your trip.