Nitroglycerin 0.1 Mg/hr Patch

Nitroglycerin is an organic nitrate that acts as a vasodilator. It is converted to nitric oxide (NO) in vascular smooth muscle cells. NO activates guanylate cyclase, increasing cyclic guanosine monophosphate (cGMP), which leads to dephosphorylation of myosin light chains and relaxation of smooth muscle. This results in venodilation (primary effect, reducing preload and myocardial oxygen demand) and, at higher doses, arterial dilation (reducing afterload). It also dilates coronary arteries, improving blood flow to ischemic areas.

Urgent Side Effects: Seek Medical Help Right Away

While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Abnormal heartbeat (fast, slow, or irregular)
Flushing
Blurred vision
Dry mouth
Excessive sweating
Pale skin
Severe nausea or vomiting
Restlessness
Feeling extremely tired or weak
New or worsening chest pain

Other Possible Side Effects

Like all medications, this drug can cause side effects in some people. Although many individuals may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for guidance:

Dizziness or headache
Skin irritation
* Headaches (common when starting the medication, but often improve over time; consult your doctor for ways to manage this side effect)

Reporting Side Effects

This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Describe the allergic reaction you experienced, including the symptoms that occurred.
Certain health conditions, including:
+ Anemia
+ Increased pressure in the head, which may be caused by bleeding in the brain or a head injury
+ Recent heart attack
+ Heart problems
+ Low blood volume
If you are currently taking any of the following medications:
+ Avanafil
+ Riociguat
+ Sildenafil
+ Tadalafil
+ Vardenafil
+ Dihydroergotamine
+ Ergonovine
+ Ergotamine
+ Methylergonovine
If you have an allergy to adhesives

This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without consulting your doctor first.

Important Information to Share with Your Healthcare Team

Inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure your safety and prevent potential interactions with other treatments.

Precautions to Take While Using This Medication

To minimize the risk of accidents, avoid driving and other activities that require alertness and clear vision until you understand how this medication affects you. When changing positions, such as standing up from a sitting or lying down position, do so slowly to reduce the likelihood of dizziness or fainting. Be cautious when navigating stairs.

Monitoring Your Condition

Follow your healthcare provider's instructions for checking your blood pressure regularly. Additionally, be aware that this medication may interfere with certain laboratory tests, so inform all your healthcare providers and laboratory personnel that you are taking this medication.

Interactions to Avoid

Do not consume alcohol while taking this medication, as it may increase the risk of adverse effects. If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.

Special Considerations

This medication is not intended to treat sudden chest pain, so do not use it for this purpose. If you have been taking this medication continuously without a break, it may lose its effectiveness over time, a phenomenon known as tolerance. To avoid this, your healthcare provider may recommend a daily "nitrate-free" period. If you experience a decrease in the medication's effectiveness, consult your doctor. Do not exceed the prescribed dose, and do not stop taking this medication abruptly without consulting your doctor, as this may increase the risk of side effects. If you need to discontinue this medication, your doctor will guide you on how to do so gradually.

Additional Safety Precautions

The patch form of this medication may contain metal, so remove it before undergoing an MRI or cardioversion. After removing the patch, your skin may appear red or feel warm, but this is usually temporary and harmless. If these effects persist, contact your doctor.

Pregnancy and Breastfeeding

If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor, as they will need to discuss the potential benefits and risks of this medication with you and determine the best course of action for you and your baby.

• Phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil, avanafil) - concurrent use can cause profound hypotension, myocardial infarction, and death.
• Riociguat (soluble guanylate cyclase stimulator) - concurrent use can cause profound hypotension.

• Alcohol (ethanol) - may enhance hypotensive effects.
• Antihypertensives (e.g., beta-blockers, calcium channel blockers, diuretics, ACE inhibitors) - additive hypotensive effects.
• Ergot alkaloids (e.g., ergotamine, dihydroergotamine) - nitrates may reduce the anti-anginal effect of nitrates and lead to increased vasoconstriction.

• Aspirin - may increase nitroglycerin levels and effects.
• Heparin - may decrease the anticoagulant effect of heparin (monitor aPTT).

• Headache (common, often transient, may indicate efficacy)
• Dizziness or lightheadedness (signs of hypotension)
• Flushing
• Nausea
• Palpitations
• Blurred vision

Category C. Use only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects at high doses, but human data are limited.

L3 (Moderately Safe). It is not known if nitroglycerin is excreted in human milk. Use with caution. Monitor infant for signs of hypotension or methemoglobinemia.

Safety and efficacy have not been established in pediatric patients. Not recommended for routine use in this population.

Use with caution in elderly patients, who may be more susceptible to hypotensive effects and falls. Start with lower doses and titrate slowly. Monitor blood pressure closely.

• The nitrate-free interval (typically 10-12 hours daily) is critical to prevent the development of nitrate tolerance, which can render the medication ineffective.
• Headache is a very common side effect, especially at the beginning of therapy. It often diminishes with continued use and can be managed with mild analgesics (e.g., acetaminophen). It can also be an indicator of drug efficacy.
• Patients should be advised to remove the patch before showering or bathing, although some patches are designed to be water-resistant. Always follow specific product instructions.
• Proper disposal of used patches is important, as they still contain residual drug. Fold the adhesive sides together and dispose of them out of reach of children and pets.
• Inform patients about the severe and potentially fatal interaction with PDE5 inhibitors (e.g., Viagra, Cialis) and riociguat. Emphasize that these drugs must not be taken concurrently.

• Oral nitrates (e.g., isosorbide mononitrate, isosorbide dinitrate)
• Beta-blockers (e.g., metoprolol, atenolol)
• Calcium channel blockers (e.g., amlodipine, diltiazem, verapamil)
• Ranolazine
• Sublingual nitroglycerin (for acute angina attacks, not prophylaxis)

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.