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nitroglycerin

Pronunciation

Generic Name: nitroglycerin (transdermal) (NYE troe GLIS er in (trans DERM al))
Brand Name: Minitran, Nitro TD Patch-A, Nitro-Dur

What is nitroglycerin transdermal?

Nitroglycerin is in a group of drugs called nitrates. Nitroglycerin dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump.

Nitroglycerin transdermal (skin patch) is used to prevent attacks of chest pain (angina). This medicine will not treat an angina attack that has already begun.

Nitroglycerin transdermal may also be used for purposes not listed in this medication guide.

What is the most important information I should know about nitroglycerin transdermal?

You should not use this medicine if you are allergic to any type of adhesive on a bandage or other transdermal skin patch.

Do not take erectile dysfunction medicine (Viagra, Cialis, and others) while you are using nitroglycerin transdermal, or you could have a sudden and serious decrease in blood pressure.

What should I discuss with my healthcare provider before using nitroglycerin transdermal?

You should not use this medication if you are allergic to nitroglycerin or other nitrates (isosorbide mononitrate, isosorbide dinitrate). Do not use nitroglycerin transdermal if you are allergic to any type of adhesive on a bandage or other transdermal skin patch.

Do not take erectile dysfunction medicine (Viagra, Cialis, Levitra, sildenafil, avanafil, tadalafil, vardenafil) while you are using nitroglycerin transdermal. Using erectile dysfunction medicine with nitroglycerin can cause a sudden and serious decrease in blood pressure.

To make sure nitroglycerin is safe for you, tell your doctor if you have:

  • congestive heart failure;

  • a buildup of fluid around your heart;

  • kidney disease (or if you are on dialysis);

  • history of head injury or brain tumor; or

  • if you have recently had a heart attack.

FDA pregnancy category C. It is not known whether nitroglycerin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

It is not known whether nitroglycerin transdermal passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I use nitroglycerin transdermal?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Wash your hands after applying or removing a skin patch.

Apply the patch to clean, dry, and hairless skin on your chest or the outer part of your upper arm. To remove any hair from these skin areas, clip the hair short but do not shave it. Press the patch firmly into place with the palm of your hand. Make sure it is well sealed around the edges.

Choose a different place on your body to wear the patch each time you put on a new one.

Do not wear more than one nitroglycerin transdermal patch at a time. Using extra skin patches will not make the medication more effective. Never cut a skin patch.

The nitroglycerin skin patch is usually worn for 12 to 14 hours and then removed. A new patch is put on after a "patch-free" period of 10 to 12 hours. Your doctor may want you to wear the patch for longer or shorter periods of time. Follow your doctor's instructions carefully.

Nitroglycerin transdermal can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use nitroglycerin transdermal. Do not stop using the medicine. Ask your doctor before using any headache pain medication.

You may leave the patch on while bathing, showering, or swimming. If a patch falls off, try sticking it back into place. If it does not stick well, put on a new patch.

Nitroglycerin transdermal will not work fast enough to treat an angina attack. Your doctor may prescribe a fast-acting medicine to treat an angina attack. Tell your doctor if it seems like any of your medicines don't work as well in treating or preventing angina attacks.

If you need surgery or medical tests, tell the surgeon or doctor ahead of time that you are using nitroglycerin transdermal. The skin patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.

If you need emergency heart resuscitation, your family or caregivers should tell emergency medical personnel if you are wearing a nitroglycerin skin patch. The patch should be removed before any electrical equipment (such as a defibrillator) is used on you.

After removing a skin patch fold it in half, sticky side in, and throw it away in a place where children or pets cannot get to it. Keep both used and unused nitroglycerin skin patches out of the reach of children or pets.

Do not stop using this medicine without your doctor's advice, even if you feel fine. You may have increased angina attacks if you stop using the medication suddenly.

Store at room temperature, away from moisture and heat. Do not refrigerate. Keep each skin patch in its sealed pouch until you are ready to use it.

What happens if I miss a dose?

Apply a patch as soon as you remember, and keep it on for the rest of your wearing time without changing your patch removal schedule. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra patches to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. The amount of nitroglycerin in a used skin patch could be dangerous to a child or pet who accidentally chews on the patch. Seek emergency medical attention if this happens.

Overdose symptoms may include severe or throbbing headache, vision problems, confusion, spinning sensation, pounding heartbeats or fluttering in your chest, stomach cramps, vomiting, gasping for breath, sweating, cold and clammy skin, slow heart rate, weak or shallow breathing, fainting, and seizure.

What should I avoid while using nitroglycerin transdermal?

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Drinking alcohol can increase certain side effects of nitroglycerin.

Nitroglycerin transdermal side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • worsening chest pain, slow heart rate;

  • a light-headed feeling, like you might pass out;

  • pale or blue colored appearance in your fingers or toes; or

  • heart attack symptoms--chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating.

Side effects such as low blood pressure and severe dizziness may be more likely in older adults.

Common side effects may include:

  • headache; or

  • mild dizziness.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Nitroglycerin dosing information

Usual Adult Dose for Angina Pectoris:

For relief of acute anginal attack:

Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue every 3 to 5 minutes as needed, up to 3 sprays in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.

Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed, up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Angina Pectoris Prophylaxis:

Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack

Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack

Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. If angina occurs while the ointment is in place, the dose should be increased; if angina occurs several hours after application, the dosing frequency should be increased. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.

Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.

Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. If angina occurs while a tablet is in place, the dose should be increased to the next strength; if angina occurs after dissolution of tablet, the dosing frequency should be increased. Usual maintenance dosage is 2 mg three times a day. If an acute attack occurs while a tablet is in place, another tablet may be administered on the opposite side from the one already in place. Sublingual nitroglycerin is recommended if prompt relief is not attained.

Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours

Because tolerance to nitroglycerin may develop if plasma levels are maintained continuously, a nitrate free interval of 10 to 12 hours per day may be appropriate during chronic prophylaxis of angina pectoris. However, clinical studies suggest that such intermittent use may be associated with hemodynamic rebound during drug withdrawal and decreased exercise tolerance during the latter part of the nitrate free interval. Although the clinical relevance of this observation is unknown, a potentially increased risk of anginal attack during the nitrate free interval should be considered. Therefore, dosing regimens should be carefully individualized to each patient. Other antianginal drugs such as beta-blockers and calcium channel blockers may be prescribed to reduce the risk of aggravating myocardial ischemia during the drug free intervals.

Usual Adult Dose for Congestive Heart Failure:

Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.

Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.

Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. Usual maintenance dosage is 2 mg three times a day.

Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours

Usual Adult Dose for Myocardial Infarction:

For the initial 24 to 48 hours after an acute myocardial infarction:

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Hypertension:

IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 100 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.

Usual Adult Dose for Anal Fissure and Fistula:

For the treatment of moderate to severe pain associated with chronic anal fissure:
Apply 1 inch of ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra anally every 12 hours for up to 3 weeks.

Usual Pediatric Dose for Hypertension:

Perioperative hypertension or induction of intraoperative hypotension:

IV continuous infusion: 0.25 to 0.5 mcg/kg/min initially, increase by 0.5 to 1 mcg/kg/min every 3 to 5 minutes as needed up to 5 mcg/kg/min. Usual dose is 1 to 3 mcg/kg/min, but doses as high as 20 mcg/kg/min have been used.

What other drugs will affect nitroglycerin transdermal?

Other drugs may interact with nitroglycerin transdermal, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about nitroglycerin transdermal.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 11.01. Revision Date: 2014-02-07, 7:28:45 PM.

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