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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, or if you are using medicine to treat pulmonary arterial hypertension (PAH), such as riociguat, (Adempas), sildenafil (Revatio), or tadalafil (Adcirca).

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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 medicine if you are allergic to nitroglycerin or other nitrates (isosorbide mononitrate, isosorbide dinitrate), or if:

  • you are allergic to any type of adhesive on a bandage or other transdermal skin patch; or

  • you are using medicine to treat pulmonary arterial hypertension (PAH), such as riociguat (Adempas), sildenafil (Revatio), or tadalafil (Adcirca).

Do not take erectile dysfunction medicine (Viagra, Cialis, Levitra, Stendra, Staxyn, 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.

You may have very low blood pressure while taking this medicine. Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual.

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; or

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

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

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:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Treatment of angina pectoris in patients who have not responded to sublingual nitroglycerin and beta-blockers.


LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue every 5 minutes as needed, up to 3 sprays in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to inhale or swallow this medication.

Use: Acute relief of an anginal attack.


SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes; if pain persists after maximum dose, prompt medical attention is recommended

Comments:
-Administer while sitting down due to rapid onset.
-Advise patient not to chew or swallow this medication.

Use: Acute relief of an anginal attack.

Usual Adult Dose for Angina Pectoris Prophylaxis:

LINGUAL SPRAY:
1 to 2 sprays (0.4 to 0.8 mg) on or under tongue 5 to 10 minutes prior to activity that might precipitate an acute attack

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to inhale or swallow this medication.


SUBLINGUAL TABLET:
0.3 to 0.6 mg sublingually or in the buccal pouch 5 to 10 minutes prior to engaging in activities that might precipitate an acute attack

Comments:
-Administer while sitting due to rapid onset.
-Advise patient not to chew or swallow this medication.


TOPICAL OINTMENT:
1/2 inch (7.5 mg) topically upon rising and 1/2 inch (7.5 mg) 6 hours later; titrate as needed and tolerated

Comments:
-Clinical trial doses have ranged from 1/2 to 2 inches (7.5 to 30 mg) applied to 36 square inches of truncal skin.
-Ointment should be applied to a dry and hairless area of the trunk.


TRANSDERMAL PATCH:
0.2 to 0.4 mg/hr patch applied topically once a day for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr

Comments:
-Patch should be applied to a dry and hairless area of the upper arm or body; rotate application sites to avoid skin irritation.
-Doses between 0.4 and 0.8 mg/hr have shown continued effectiveness for 10 to 12 hours daily for at least 1 month of intermittent administration.


EXTENDED RELEASE CAPSULE:
2.5 to 6 mg orally 3 to 4 times a day; titrate as needed and tolerated

Comments:
-Subjects were titrated up to 26 mg four times a day in one clinical trial.

Usual Adult Dose for Myocardial Infarction:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Use: Control of congestive heart failure in the setting of acute myocardial infarction.

Usual Adult Dose for Hypertension:

INTRAVENOUS SOLUTION:
5 mcg/min continuous IV infusion via non-absorptive tubing; increase by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then by 10 or 20 mcg/min if needed

Comments:
-Starting doses of 25 mcg/min or higher have been used with polyvinyl chloride (PVC) tubing.
-Lower concentrations increase potential dosing precision and volume to be delivered; consider patient fluid requirements and expected infusion duration when selecting an appropriate dilution.

Uses:
-Treatment of perioperative hypertension.
-Induction of intraoperative hypotension.

Usual Adult Dose for Anal Fissure and Fistula:

RECTAL OINTMENT:
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

Comments:
-A finger covering such as plastic wrap, a disposable surgical glove, or a finger cot should be placed on the finger to apply ointment.
-Insert finger no further than first finger joint and apply around side of anal canal; if unable to insert finger due to pain, apply directly to outside of anus.

Use: Treatment of moderate to severe pain associated with chronic anal fissure.

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: 11.02. Revision Date: 2014-11-17, 11:39:17 AM.

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