Nitroglycerin Transdermal Patch

Nitroglycerin transdermal patches are used to prevent episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Nitroglycerin transdermal patches can only be used to prevent attacks of angina; they cannot be used to treat an attack of angina once it has begun. Nitroglycerin is in a class of medications called vasodilators. It works by relaxing the blood vessels so that the heart does not need to work as hard and therefore does not need as much oxygen.

Transdermal nitroglycerin comes as a patch to apply to the skin. It is usually applied once a day, worn for 12 to 14 hours, and then removed. Apply nitroglycerin patches at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use nitroglycerin patches exactly as directed. Do not apply more or fewer patches or apply the patches more often than prescribed by your doctor.

Choose a spot on your upper body or upper arms to apply your patch. Do not apply the patch to your arms below the elbows, to your legs below the knees, or to skin folds. Apply the patch to clean, dry, hairless skin that is not irritated, scarred, burned, broken, or calloused. Choose a different area each day.

You may shower while you are wearing a nitroglycerin skin patch.

If a patch loosens or falls off, replace it with a fresh one.

To use nitroglycerin patches, follow the steps below. Different brands of nitroglycerin patches may be applied in slightly different ways, so be sure to follow the directions included with your patches:

1. Wash your hands.
2. Hold the patch so that the plastic backing is facing you.
3. Bend the sides of the patch away from you and then toward you until you hear a snap.
4. Peel off one side of the plastic backing.
5. Use the other side of the patch as a handle, and apply the stick half to your skin in the spot you have chosen.
6. Press the sticky side of the patch against the skin and smooth it down.
7. Fold back the other side of the patch. Hold onto the remaining piece of plastic backing and use it to pull the patch across the skin.
8. Wash your hands again.
9. When you are ready to remove the patch, press down on its center to lift the edges away from the skin.
10. Hold the edge gently and slowly peel the patch away from the skin.
11. Fold the patch in half with the sticky side pressed together and dispose of it safely, out of the reach of children and pets. The used patch may still contain active medication that can harm others.
12. Wash the skin that was covered with the patch with soap and water. The skin may be red and may feel warm for a short time. You may apply lotion if the skin is dry, and you should call your doctor if the redness does not go away after a short time.

Nitroglycerin patches may no longer work as well after you have used them for some time. To prevent this, your doctor will probably tell you to wear each patch for only 12 to 14 hours each day so that there is a period of time when you are not exposed to nitroglycerin every day. If your angina attacks happen more often, last longer, or become more severe at any time during your treatment, call your doctor.

Nitroglycerin patches help prevent attacks of angina but do not cure coronary artery disease. Continue to use nitroglycerin patches even if you feel well. Do not stop using nitroglycerin patches without talking to your doctor.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using nitroglycerin patches,

• tell your doctor and pharmacist if you are allergic to nitroglycerin patches, tablets, spray, or ointment; any other medications; adhesives; or any of the ingredients in nitroglycerin skin patches. Ask your pharmacist for a list of the ingredients.
• some medications should not be taken with nitroglycerin patch. Other medications may cause dosing changes or extra monitoring when taken with nitroglycerin patch. Make sure you have discussed any medications you are currently taking or plan to take before starting nitroglycerin patch with your doctor and pharmacist. Before starting, stopping, or changing any medications while using nitroglycerin patch, please get the advice of your doctor or pharmacist.
• tell your doctor if you think you may be dehydrated, if you have recently had a heart attack, and if you have or have ever had heart failure, low blood pressure, or hypertrophic cardiomyopathy (thickening of the heart muscle).
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using nitroglycerin patches, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using nitroglycerin patches.
• ask your doctor about the safe use of alcoholic beverages while you are using nitroglycerin skin patches. Alcohol can make the side effects from nitroglycerin patches worse.
• you should know that nitroglycerin patches may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position, or at any time, especially if you have been drinking alcoholic beverages. To avoid this problem, get up slowly, resting your feet on the floor for a few minutes before standing up. Take extra precautions to avoid falling during your treatment with nitroglycerin patches.
• you should know that you may experience headaches every day during your treatment with nitroglycerin patches. These headaches may be a sign that the medication is working as it should. Do not try to change the times or the way that you apply nitroglycerin patches to avoid headaches because then the medication may not work as well. Your doctor may tell you to take a pain reliever to treat your headaches.

Unless your doctor tells you otherwise, continue your normal diet.

Apply the missed patch as soon as you remember it. If it is almost time to apply your next patch, skip the missed patch and continue your regular dosing schedule. Remove your patch at your regularly scheduled time even if you applied it later than usual. Do not apply two patches to make up for a missed dose.

Nitroglycerin patches may cause side effects. Tell your doctor if any of these symptoms or those listed in the SPECIAL PRECAUTIONS section are severe or do not go away:

• redness or irritation of the skin that was covered by the patch
• flushing

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• slow or fast heartbeat
• worsening chest pain
• rash
• hives
• itching
• difficulty breathing or swallowing

Nitroglycerin patches may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• headache
• confusion
• fever
• dizziness
• slow or pounding heartbeat
• nausea
• vomiting
• bloody diarrhea
• fainting
• shortness of breath
• sweating
• flushing
• cold, clammy skin
• loss of ability to move the body
• coma (loss of consciousness for a period of time)
• seizures

Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

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