Generic Name: nitroglycerin (transdermal) (NYE troe GLIS er in)
Brand Names: Minitran, Nitrek, Nitro TD Patch-A, Nitro-Dur
What is nitroglycerin transdermal?
Nitroglycerin is in a group of drugs called nitrates. Nitroglycerin dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump.
Nitroglycerin transdermal is used to prevent attacks of chest pain (angina).
Nitroglycerin transdermal may also be used for purposes not listed in this medication guide.
What is the most important information I should know about nitroglycerin transdermal?
You should not use this medication if you are allergic to nitroglycerin, isosorbide mononitrate (Imdur), or isosorbide dinitrate (BiDil, Isordil).
Before using nitroglycerin transdermal, tell your doctor if you have congestive heart failure, low blood pressure, glaucoma, anemia, or a history of heart attack, stroke, or head injury.
Do not use this medication to treat an angina attack that has already begun. It will not work fast enough.
Nitroglycerin transdermal can cause severe headaches, especially when you first start using it. Do not stop using the skin patches, and ask your doctor before using any headache pain medication.
Nitroglycerin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Call your doctor at once if you have a serious side effect such as worsening chest pain, pain spreading to the arm or shoulder, nausea, vomiting, sweating, blurred vision and dry mouth, or fainting. Drinking alcohol can increase certain side effects of nitroglycerin. The nitroglycerin transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.
What should I discuss with my healthcare provider before using nitroglycerin transdermal?
You should not use this medication if you are allergic to nitroglycerin, isosorbide mononitrate (Imdur), or isosorbide dinitrate (BiDil, Isordil). Do not use nitroglycerin transdermal if you are allergic to any type of adhesive on a bandage or other transdermal skin patch.
To make sure you can safely use nitroglycerin, tell your doctor if you have any of these other conditions:
congestive heart failure;
a history of heart attack, stroke, or head injury;
low blood pressure;
glaucoma; or
anemia (lack of red blood cells).
FDA pregnancy category C. It is not known whether nitroglycerin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether nitroglycerin transdermal passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
How should I use nitroglycerin transdermal?
Use exactly as prescribed by your doctor. Do not use in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.
Do not use nitroglycerin transdermal to treat an angina attack that has already begun. It will not work fast enough. Your doctor may prescribe an oral form of nitroglycerin (tablet, capsule, spray) to treat an angina attack. Talk with your doctor if any of your medications do not seem to work as well in treating or preventing angina attacks.
The nitroglycerin transdermal skin patch is usually worn for 12 to 14 hours and then removed. A new patch is put on after a "patch-free" period of 10 to 12 hours. Your doctor may want you to wear the patch for longer or shorter periods of time. Follow your doctor's instructions carefully.
Apply the skin patch to a clean, dry, hairless area of the body, below your neck and above your knees or elbows. To remove any hair from these skin areas, clip the hair short but do not shave it.
Press the patch onto the skin and press it down firmly with your fingers. Make sure it is well sealed around the edges.
Wash your hands after applying a nitroglycerin transdermal skin patch.
If the patch falls off, try sticking it back on. If you replace the patch with a new one, leave it on only for the rest of your wearing time. Do not change your patch removal schedule.
After removing a skin patch fold it in half, sticky side in, and throw it away in a place where children or pets cannot get to it. Keep both used and unused nitroglycerin skin patches out of the reach of children or pets. Do not stop using this medication without your doctor's advice, even if you feel better. You may have increased angina attacks if you stop using the medication suddenly.
If you need to have any type of surgery or dental work, tell the surgeon or dentist ahead of time that you are using nitroglycerin transdermal.
The nitroglycerin transdermal patch may burn your skin if you wear the patch during an MRI (magnetic resonance imaging). Remove the patch before undergoing such a test.
Tell any doctor or other healthcare provider who treats you that you are using nitroglycerin transdermal. If you need emergency heart resuscitation, your family or caregivers should tell emergency medical personnel if you are wearing a nitroglycerin skin patch. The patch should be removed before any electrical equipment (such as a defribrillator) is used on you.
Store at room temperature, away from moisture and heat. Keep each skin patch in its sealed pouch until you are ready to use it.
What happens if I miss a dose?
Apply a patch as soon as you remember, and keep it on for the rest of your wearing time without changing your patch removal schedule. If you miss a dose and it is almost time to apply your next patch, wait until then to apply the patch and skip the missed dose.
Do not use extra patches to make up a missed dose.
What happens if I overdose?
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include a severe throbbing headache, confusion, fever, fast or pounding heartbeats, dizziness, vision problems, nausea, vomiting, bloody diarrhea, trouble breathing, cold or clammy skin, feeling light-headed, fainting, seizure (convulsions), or blue-colored skin, lips, or nails.
What should I avoid while using nitroglycerin transdermal?
Avoid using nitroglycerin transdermal on irritated or broken skin.
Nitroglycerin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Drinking alcohol can increase certain side effects of nitroglycerin.
Nitroglycerin transdermal side effects
Nitroglycerin transdermal can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use nitroglycerin transdermal. Do not stop using the medication. Ask your doctor before using any headache pain medication.
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:
worsening chest pain, slow heart rate;
feeling like you might pass out;
chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
fast or pounding heartbeats; or
blurred vision and dry mouth.
Less serious side effects may include:
mild skin rash or itching;
warmth, redness, or tingly feeling under your skin;
nausea, vomiting, upset stomach; or
feeling nervous, weak, or dizzy.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Nitroglycerin Dosing Information
Usual Adult Dose for Angina Pectoris:
For relief of acute anginal attack:
Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue every 3 to 5 minutes as needed, up to 3 sprays in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.
Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch every 5 minutes as needed, up to 3 doses in 15 minutes. If pain persists after the maximum number of doses, prompt medical attention is recommended.
IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed, up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.
Usual Adult Dose for Angina Pectoris Prophylaxis:
Lingual spray: 1 to 2 sprays (0.4 to 0.8 mg) onto or under the tongue 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack
Sublingual tablet: 0.3 to 0.6 mg dissolved under the tongue or in the buccal pouch 5 to 10 minutes prior to engaging in activities which might precipitate an acute attack
Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. If angina occurs while the ointment is in place, the dose should be increased; if angina occurs several hours after application, the dosing frequency should be increased. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.
Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.
Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. If angina occurs while a tablet is in place, the dose should be increased to the next strength; if angina occurs after dissolution of tablet, the dosing frequency should be increased. Usual maintenance dosage is 2 mg three times a day. If an acute attack occurs while a tablet is in place, another tablet may be administered on the opposite side from the one already in place. Sublingual nitroglycerin is recommended if prompt relief is not attained.
Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours
Because tolerance to nitroglycerin may develop if plasma levels are maintained continuously, a nitrate free interval of 10 to 12 hours per day may be appropriate during chronic prophylaxis of angina pectoris. However, clinical studies suggest that such intermittent use may be associated with hemodynamic rebound during drug withdrawal and decreased exercise tolerance during the latter part of the nitrate free interval. Although the clinical relevance of this observation is unknown, a potentially increased risk of anginal attack during the nitrate free interval should be considered. Therefore, dosing regimens should be carefully individualized to each patient. Other antianginal drugs such as beta-blockers and calcium channel blockers may be prescribed to reduce the risk of aggravating myocardial ischemia during the drug free intervals.
Usual Adult Dose for Congestive Heart Failure:
Topical ointment: 1/2 inch initially, applied to a non hairy area of the trunk every 6 to 8 hours during waking hours (2 times a day); titrate as needed and tolerated. Usual range is 1/2 to 2 inches (7.5 to 30 mg) every 8 hours, typically applied to 36 square inches of truncal skin.
Transdermal patch: 0.1 to 0.4 mg/hr patch applied to a dry and hairless area of the upper arm or body for 12 to 14 hours per day; titrate as needed and tolerated up to 0.8 mg/hr. Application sites should be rotated to avoid skin irritation.
Transmucosal (buccal) tablet: 1 mg dissolved between the lip and gum above the upper incisors or between the cheek and gum every 3 to 5 hours during waking hours (approximately 3 times a day); titrate as needed and tolerated. Usual maintenance dosage is 2 mg three times a day.
Oral: 2.5 every 8 to 12 hours; titrate as needed and tolerated up to 9 mg every 8 to 12 hours
Usual Adult Dose for Myocardial Infarction:
For the initial 24 to 48 hours after an acute myocardial infarction:
IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 200 and generally no more than 400 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.
Usual Adult Dose for Hypertension:
IV continuous infusion (via non PVC tubing): 5 mcg/min initially, increased by 5 mcg/min every 3 to 5 minutes as needed up to 20 mcg/min, then gradually by 10 and then 20 mcg/min if needed up to a usual maximum of 100 mcg/min. Starting dosages of 25 mcg/min or higher have been used with PVC administration sets.
Usual Adult Dose for Anal Fissure and Fistula:
For the treatment of moderate to severe pain associated with chronic anal fissure:
Apply 1 inch of ointment (375 mg of ointment equivalent to 1.5 mg of nitroglycerin) intra anally every 12 hours for up to 3 weeks.
Usual Pediatric Dose for Hypertension:
Perioperative hypertension or induction of intraoperative hypotension:
IV continuous infusion: 0.25 to 0.5 mcg/kg/min initially, increase by 0.5 to 1 mcg/kg/min every 3 to 5 minutes as needed up to 5 mcg/kg/min. Usual dose is 1 to 3 mcg/kg/min, but doses as high as 20 mcg/kg/min have been used.
What other drugs will affect nitroglycerin transdermal?
Tell your doctor about all other medications you use, especially:
blood pressure medication or diuretics (water pills);
cold or allergy medicines, diet pills, or over-the-counter pain medicine such as ibuprofen (Advil, Motrin) or naproxen (Aleve);
an erectile dysfunction medication such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra);
migraine headache medication such as ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (D.H.E. 45, Migranal), or methylergonovine (Methergine);
a beta-blocker such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Dutoprol, Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal, InnoPran), sotalol (Betapace), and others; or
heart or blood pressure medicine such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta), diltiazem (Cartia, Cardizem), nifedipine (Nifedical, Procardia), verapamil (Calan, Covera, Isoptin, Verelan), and others.
This list is not complete and other drugs may interact with nitroglycerin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
More nitroglycerin resources
- Nitroglycerin Side Effects (in more detail)
- Nitroglycerin Dosage
- Nitroglycerin Use in Pregnancy & Breastfeeding
- Drug Images
- Nitroglycerin Drug Interactions
- Nitroglycerin Support Group
- 6 Reviews for Nitroglycerin - Add your own review/rating
Compare nitroglycerin with other medications
- Anal Fissure and Fistula
- Angina
- Angina Pectoris Prophylaxis
- Heart Attack
- Heart Failure
- High Blood Pressure
- Raynaud's Syndrome
Where can I get more information?
- Your pharmacist can provide more information about nitroglycerin transdermal.
See also: nitroglycerin side effects (in more detail)
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