Adult Dosing
Prophylaxis against chronic anginal attacks
- Initial: Apply 0.2 to 0.4 mg/hr patch qd
- Titrate: Increase dose to desired response. Max: 0.4-0.8 mg/hr qd
Notes- Apply transdermal pad or disc to hairless site
- Can be applied at the upper arm, back, shoulders, or chest
- Nitroglycerine patches should be attached for at least 12-14 hrs
- Follow nitroglycerin free intervals of 10 to 12 hours to prevent tolerance
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
See Supplemental Patient Information
- Concomitant use with sildenafil causes severe hypotension by amplification of the vasodilatory effects of nitroglycerin, the time course, dose dependence and appropriate supportive care of this interaction has not been studied; treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion
- Monitor clinical or hemodynamic parameters when given in acute MI and CHF, as efficacy of transdermal nitroglycerin in these patients has not been established
- Do not discharge a defibrillator or cardiovertor through a paddle electrode that overlies a nitroglycerin transdermal patch
- 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 demonstrates physical dependence and causes chest pain, acute myocardial infraction, and even sudden death during temporary withdrawal
- Advise patients of the risk of burns associated with the use of the drug patches during MRI screening; alert doctor about the presence of the patch before MRI Scan
- To prevent tolerance, follow nitroglycerin free intervals of 10-12hr
Cautions: Use cautiously in
- Volume depletion
- Hypotension
- Acute MI
- CHF
- Methemoglobinemia
- Increased ICP
- Geriatric population(increased frequency of decreased hepatic, cardiac, renal function)
- Head injury
- Cerebral hemorrhage
Supplemental Patient Information
- Do not apply the drug to the lower arm/lower leg
- Apply the patch to a nonhairy dry area so that hair will not prevent direct contact of the patch with the skin
- Prevent accidental application or ingestion by children or others
- 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
Pregnancy Category:C
Breastfeeding: Safety unknown, manufacturer advises caution as many drugs are excreted in human milk
Pricing data from www.DrugStore.com in U.S.A.
- Nitro-Dur 0.2 MG/HR PT24 [Box] (KEY)
30 hr = $112.99
90 hr = $315.97 - Nitro-Dur 0.4 MG/HR PT24 [Box] (KEY)
30 hr = $127.07
90 hr = $355.79 - Minitran 0.1 MG/HR PT24 [Box] (GRACEWAY PHARMACEUTICALS)
30 hr = $79.99
90 hr = $229.98 - Nitro-Dur 0.3 MG/HR PT24 [Box] (KEY)
30 hr = $125.99
90 hr = $377.97 - Nitro-Dur 0.1 MG/HR PT24 [Box] (KEY)
30 hr = $101.65
90 hr = $286.94 - Minitran 0.6 MG/HR PT24 [Box] (GRACEWAY PHARMACEUTICALS)
30 hr = $99.99
90 hr = $279.98 - Nitro-Dur 0.8 MG/HR PT24 [Box] (KEY)
30 hr = $135.98
90 hr = $375.99 - Nitro-Dur 0.6 MG/HR PT24 [Box] (KEY)
30 hr = $127.07
90 hr = $360.02
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.
