Adult Dosing

Prophylaxis against angina pectoris due to coronary artery disease

• Apply 2% ointment to approximately 0.5 inch of skin (7.5 mg) bid; first dose on rising in the morning; second dose six hours after first dose
• Increase 0.5 inch PRN. Max: 2 inch application
• Maintain nitrate free interval of 10-12 hrs daily

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Prophylaxis for angina pectoris due to coronary artery disease

• Hypersensitivity to any of the ingredients of the product
• Concomitant use of sildenafil
• Methemoglobinemia

• N/A

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

See Supplemental Patient Information

• Use of sildenafil results in severe hypotension by amplification of the vasodilatory effects of nitroglycerin; the time course and dose dependence of this interaction have not been studied; appropriate supportive care has not been studied, treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion
• Efficacies of transdermal nitroglycerin in acute myocardial infarction or CHF have not been established. Monitor carefully clinical and hemodynamic parameters if used in such conditions as it causes hypotension and tachycardia
• Even small dose can cause severe hypotension, particularly in upright posture. Use cautiously in patients who may be volume-depleted or already hypotensive
• Hypotension induced by nitroglycerin may be accompanied by paradoxical bradycardia and increased angina pectoris
• Aggravates the angina caused by hypertrophic cardiomyopathy
• Dull exercise tolerance is observed with sublingual nitroglycerin therapy
• Long term exposure to nitroglycerin results in physical dependence and causes chest pain, acute myocardial infarction, and even sudden death has occurred during temporary withdrawal
• To prevent tolerance, follow nitroglycerin free intervals of 10-12hrs
• The onset of action of transdermal nitroglycerin is not rapid enough to treat acute anginal attack

Use cautiously in

• Volume depletion
• Hypotension
• Increased ICP
• Acute MI
• CHF
• Cerebral hemorrhage
• Head injury
• Methemoglobinemia
• Geriatric population
• Idiopathic hypertrophic subaortic stenosis

Supplemental Patient Information

• Nitroglycerin causes daily headaches; headaches are the marker of the activity of the drug; as the loss of headache is associated with simultaneous loss of antianginal efficacy, advise patient not to alter/stop nitroglycerin treatment regimen

Nitro-Bid interacts with :

	Adcirca
	Cialis
	Levitra
	Revatio
	Sildenafil
	Staxyn
	Tadalafil
	Vardenafil
	Viagra

Pregnancy Category:C

Breastfeeding: Topical use of nitroglycerin for anal fissures by nursing mothers does not have any adverse effects on their breastfed infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 9th December 2010). According to manufacturer's data, excretion of topically administered nitroglycerin in breastmilk is unknown; caution advised.

• CV: Hypotension, bradycardia, syncope, crescendo angina, rebound hypertension, reflex tachycardia, peripheral edema
• CNS: Recurrent headache, light-headedness, dizziness
• DERM: Contact dermatitis/fixed drug eruptions, flushing
• HEMA: Methemoglobinemia
• LOCAL: Anaphylactoid reactions
• MISC: Tolerance/dependence

• Organic nitrate, vasodilator; stimulates the synthesis of cGMP which results in the relaxation of vascular smooth muscle and vasodilatation. Dilatation of the veins decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure.Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure
• Primarily metabolized in the liver by nitrate reductase; converted to inorganic nitrate and the active 1,2 and 1,3 dinitroglycerols; CYP450: unknown
• Extrahepatic sites of metabolism include RBC and vascular walls
• Excretion: Renally excreted
• Half life: 3 mins

US Trade Name(s)

• Nitro-Bid

US Availability

nitroglycerin (generic)

• OINT: 2%

Nitro-Bid

• OINT: 2%

Canadian Trade Name(s)

• Nitrol

Canadian Availability

Nitrol

• OINT: 2%

UK Trade Name(s)

• Rectogesic

UK Availability

Rectogesic (anorectal application for different indication)

• Rectal ointment: 4 mg/g

Australian Trade Name(s)

• Rectogesic

Australian Availability

Rectogesic (anorectal application for different indication)

• Rectal ointment: 0.2%

[Outline]

Cardiovascular

Antianginal Agents

Nitrates

Cardiovascular

Vasodilators

Other

Pricing data from www.DrugStore.com in U.S.A.

• Nitro-Bid 2 % OINT [Tube] (SAVAGE)
  30 % = $29.99
  60 % = $49.97
• Nitro-Bid 2 % OINT [Tube] (FOUGERA)
  60 % = $21.99
  120 % = $34.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.