Transderm Nitro

The usual dose of Transderm Nitro (Nitroglycerin) patches varies according to need. The patch is usually applied in the morning and taken off 12 to 14 hours later (leaving 10 to 12 hours overnight without the patch).

The patch may be applied to any convenient skin area – recommended sites include the upper arm, back, shoulders, or chest. Use a different application site each time. A suitable area may be shaved if necessary. Do not apply the patch to the ends of the arms or legs. Wash your hands thoroughly after application. Following use, discard the patch in a manner that prevents accidental application or ingestion by curious pets or children.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are using the medication without consulting your doctor.

It is important to use Transderm Nitro (Nitroglycerin) exactly as prescribed by your doctor. If you miss a dose, apply a patch as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not apply a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Transderm Nitro (Nitroglycerin) at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Transderm-Nitro (Transderm Nitro (Nitroglycerin)) transdermal therapeutic system, is a flat multilayer unit designed to release Transderm Nitro (Nitroglycerin) continuously through a semipermeable membrane following its application to intact skin. In cases where permeability of the skin is excessive, drug release is limited by this release membrane.

The rate of Transderm Nitro (Nitroglycerin) release is directly related to the drug releasing area of the applied patch (see Table 1). The nominal rate of Transderm Nitro (Nitroglycerin) release in vivo is approximately 0.02 mg/cm²/hour. Transderm Nitro (Nitroglycerin) remaining in the patch serves as a thermodynamic energy source to keep the pattern of drug delivery constant.

Table 1: Transderm-Nitro Rate of Transderm Nitro (Nitroglycerin) Release

TRANSDERM-NITRO 0.2

TRANSDERM-NITRO 0.4

TRANSDERM-NITRO 0.6

Rated release of Transderm Nitro (Nitroglycerin) in vivo

0.2 mg/hour

0.4 mg/hour

0.6 mg/hour

Transderm Nitro (Nitroglycerin) content

25 mg

50 mg

75 mg

Drug releasing area

10 cm²

20 cm²

30 cm²

Printed code

TRANSDERM-NITRO
0.2 mg/hour CG DOD

TRANSDERM-NITRO
0.4 mg/hour CG DPD

TRANSDERM-NITRO
0.6 mg/hour CG EJE

Colour of protective liner
(peel off and discard)

off-white

off-white

off-white

Do not use Transderm Nitro (Nitroglycerin) if you:

• are allergic to Transderm Nitro (Nitroglycerin) or any ingredients of the medication
• are allergic to the adhesive used in Transderm Nitro (Nitroglycerin) patches
• are allergic to other nitrates or nitrites
• have acute circulatory failure associated with severe lowering of blood pressure (states of collapse or shock)
• have extremely Low Blood Pressure
• have increased eye pressure (Glaucoma)
• have increased pressure within the head (e.g., after an accident)
• have reduced heart function due to obstruction (e.g., narrowing of the heart valves)
• have severe Anemia
• have severe dizziness when getting up from a sitting or lying down position
• are using the Erectile Dysfunction medications called PDE-5 inhibitors (e.g., Sildenafil, Tadalafil, or Vardenafil)
• are taking the medication Riociguat

There may be an interaction between Transderm Nitro (Nitroglycerin) and any of the following:

• alcohol
• Aldesleukin
• Aliskiren
• alpha-agonists (e.g., Clonidine, methyldopa)
• alpha-blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• amifostine
• Amiodarone
• angiotensin converting enzyme inhibitors (ACEIs; Captopril, Enalapril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., Candesartan, Irbesartan, Losartan)
• second generation anti-psychotics (e.g., Clozapine, Olanzapine, Quetiapine, Risperidone)
• barbiturates (e.g., butalbital, pentobarbital, Phenobarbital)
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• brimonidine
• Bromocriptine
• Cabergoline
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• clonidine
• conivaptan
• Dapsone
• diazoxide
• Dipyridamole
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• Duloxetine
• Eplerenone
• ergot alkaloids (e.g., Dihydroergotamine, ergonovine, ergotamine, methylergonovine)
• Heparin
• Hydralazine
• Guanfacine
• levodopa
• Minoxidil
• other nitrates (e.g., Transderm Nitro (Nitroglycerin), isosorbide dinitrate, isosorbide mononitrate)
• Obinutuzumab
• Pentoxifylline
• phosphodiesterase 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
• prilocaine
• riociguat
• Ropinirole
• Rosiglitazone
• Selegiline
• sodium nitrite
• tetracaine
• Tizanidine
• tolcapone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Transderm Nitro (Nitroglycerin). Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Transderm Nitro (Nitroglycerin).

Acute angina attacks: Transderm Nitro (Nitroglycerin) patches are not intended for immediate relief of acute attacks of angina. Sublingual (under the tongue) Transderm Nitro (Nitroglycerin) preparations (spray or tablets) should be used for this purpose.

Dizziness/reduced alertness: People using Transderm Nitro (Nitroglycerin) may experience faintness or dizziness and reduced reaction time when driving or operating machinery, especially at the start of treatment. Avoid these and other hazardous tasks until you have determined how Transderm Nitro (Nitroglycerin) affects you.

Heart disease: The benefits and safety of using the Transderm Nitro (Nitroglycerin) patch have not been established for people who have had an acute heart attack or have Congestive Heart Failure.

Low blood pressure: Headaches or symptoms of low blood pressure such as weakness or dizziness, particularly when getting up suddenly from a sitting or lying down position, may result from taking too much Transderm Nitro (Nitroglycerin). If these symptoms occur, your doctor may reduce the dose or have you stop using the Transderm Nitro (Nitroglycerin) patch. People who might be negatively affected by low blood pressure should use Transderm Nitro (Nitroglycerin) with caution. If you take diuretics or have preexisting low blood pressure, you may be at an increased risk of experiencing this effect.

Symptom changes: If your symptoms of angina increase at any time (including during the period of the day that you aren't taking the medication), be sure to tell your doctor.

Tolerance: People who use Transderm Nitro (Nitroglycerin) may develop tolerance to the medication, resulting in it not working as well. Tolerance to other nitrates or nitrites can also happen, especially if a medication-free period is not observed each day. As tolerance to Transderm Nitro (Nitroglycerin) patches develops, the effect of fast-acting sublingual (under the tongue) Transderm Nitro (Nitroglycerin) is also somewhat reduced.

Pregnancy: Transderm Nitro (Nitroglycerin) has not been studied for use by pregnant women and should not be used during pregnancy unless the benefits outweigh the risks. Be sure to tell your doctor if you are pregnant or planning to become pregnant. If you become pregnant while using Transderm Nitro (Nitroglycerin), inform your doctor as soon as possible.

Breast-feeding: It is not known if Transderm Nitro (Nitroglycerin) passes into breast milk. If you are a breast-feeding mother and are taking Transderm Nitro (Nitroglycerin), it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of Transderm Nitro (Nitroglycerin) for children have not been established.