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nitroglycerin transdermal (Rx)Brand and Other Names:NitroDur, Minitran, more...Deponit, Transdermal Nitroglycerin, Nitrocine, glyceryl trinitrate transdermal

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

patch

  • 0.1mg/hr
  • 0.2mg/hr
  • 0.3mg/hr
  • 0.4mg/hr
  • 0.6mg/hr
  • 0.8mg/hr
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Angina Pectoris

1 Patch qDay; Start with smallest unit in series & titrate

Patches may be applied to any skin surface, except on extremities below the knees or elbows

Nitrate-free period of 10-12 hours duration (overnight) needed to prevent tolerance

Minitran 0.1, 0.2, 0.4, 0.6 mg/hr

Nitro-Dur 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr

Transdermal-nitroglyderin 0.1, 0.2, 0.4, 0.6 mg/hr

Not FDA approved in children

Angina pectoris

1 Patch qDay; Start with smallest unit in series & titrate

Patches may be applied to any skin surface, except on extremities below the knees or elbows

Nitrate-free period of 10-12 hours duration (overnight) needed to prevent tolerance

Minitran 0.1, 0.2, 0.4, 0.6 mg/hr

Nitro-Dur 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr

Transdermal-nitroglyderin 0.1, 0.2, 0.4, 0.6 mg/hr

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Interactions

Interaction Checker

nitroglycerin transdermal and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Common

            Headache

            Hypotension

            Tachycardia

            Dizziness

            Lightheadedness

            Blurred vision

            Flushing

            N/V

            Nervousness

            Xerostomia

            Topical allergic reactions

            Serious

            Methemoglobinemia (rare)

            Syncope

            Prolonged bleeding time

            Exfoliative dermatitis

            Unstable angina

            Rebound hypertension

            Thrombocytopenia

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            Warnings

            Contraindications

            Hypersensitivity to organic nitrates or adhesives

            Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life

            Concomitant administration with guanylate stimulator riociguat (may cause hypotension)

            Severe anemia

            Cautions

            Alcohol use, increased ICP (eg, head trauma, cerebral hemorrhage-potential contraindication), hyperthyroidism, hypertrophic cardiomyopathy, increased IOP, postural hypotension, volume depletion, low systolic BP

            Benefits of transdermal nitroglycerin in patients with acute myocardial infarction or congestive heart failure have not been established

            Transdermal system should not be used to treat acute angina attacks

            Severe hypotension, particularly with upright posture, may occur with even small doses of nitroglycerin, particularly in the elderly; use caution

            Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy, particularly in the elderly

            Arcing may occur if defibrillator discharged through paddle electrode overlying transdermal patch

            Discarded patches should be kept out of reach of children and pets

            Chest pain, acute myocardial infarction, and even sudden death reported during temporary withdrawal of nitrates from industrial workers with long-term exposure to unknown high doses of organic nitrates

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: not known whether the drug crosses into breast milk, use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Organic nitrate which causes systemic venodilation, decreasing preload

            Cellular mechanism: nitrate enters vascular smooth muscle & converted to nitric oxide (NO) leading to activation of cGMP & vasodilation

            Pharmacokinetics

            Half-Life: 12-33 min

            Onset: 60 min

            Duration: 10-12 hr

            Bioavailability: 75%

            Protein Bound: 60%

            Vd: 3 L/kg

            Metabolism: Mainly in liver, extrahepatic sites: vascular wall, RBC

            Metabolites: 1,3-glyceryl dinitrate, 1,2-glyceryl dinitrate, and glyceryl mononitrate (inactive)

            Clearance: 5.5-11 L/min

            Excretion: Urine

            Dialyzable: No

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            Images

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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