In the International Phonetic Alphabet it represents a nasalized version of a trill consonant, or in broader transcription also a nasalized flap or tap.
In Lithuanian, the R with tilde “R̃, r̃” is rarely used and is found in some grammar texts, dictionaries or textbooks.
It is not to be confused with Ȓ (R with inverted breve), R̄ (R with macron) or Ř (R with háček).
It was used in the Albanian Agimi alphabet for the voiced alveolar trill, now represented by the digraph Rr.
It is also used in Hausa to differentiate the alveolar tap /ɾ/, represented by R, from the retroflex one.