nitroglycerin topical (Rx)

Brand and Other Names:Nitrol, Nitro Bid, more...NitroBid Topical, glyceryl trinitrate topical, Topical Nitroglycerin

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

ointment

  • 2%

Angina Pectoris (Long-Term Prophylaxis)

0.5-2 inches applied in am and 6 hours later to truncal skin

Congestive Heart Failure

1.5 inches, increase by 0.5-1 inch up to 4 inches, q4hr

Safety and efficacy not established

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Interactions

Interaction Checker

and nitroglycerin topical

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (11)

            • avanafil

              nitroglycerin topical, avanafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • bromocriptine

              bromocriptine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • cabergoline

              cabergoline decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • dihydroergotamine

              dihydroergotamine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • dihydroergotamine intranasal

              dihydroergotamine intranasal decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • ergoloid mesylates

              ergoloid mesylates decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • ergotamine

              ergotamine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • methylergonovine

              methylergonovine decreases effects of nitroglycerin topical by pharmacodynamic antagonism. Contraindicated.

            • sildenafil

              nitroglycerin topical, sildenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • tadalafil

              nitroglycerin topical, tadalafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            • vardenafil

              nitroglycerin topical, vardenafil. Mechanism: additive vasodilation. Contraindicated. Potentially fatal hypotension.

            Serious - Use Alternative (5)

            • cabergoline

              nitroglycerin topical increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • ergoloid mesylates

              nitroglycerin topical increases effects of ergoloid mesylates by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • ergotamine

              nitroglycerin topical increases effects of ergotamine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • lofexidine

              lofexidine, nitroglycerin topical. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • methylergonovine

              nitroglycerin topical increases effects of methylergonovine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            Monitor Closely (4)

            • arginine

              nitroglycerin topical, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

            • bretylium

              nitroglycerin topical, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bupivacaine implant

              nitroglycerin topical, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

            • tetracaine

              tetracaine, nitroglycerin topical. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

            Minor (3)

            • acetylcysteine

              acetylcysteine increases effects of nitroglycerin topical by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

            • acetylcysteine (Antidote)

              acetylcysteine (Antidote) increases effects of nitroglycerin topical by Other (see comment). Minor/Significance Unknown. Comment: Acetylcysteine may enhance vasodilatory effects of nitroglycerin.

            • ethanol

              nitroglycerin topical, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

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            Adverse Effects

            Frequency Not Defined

            Headache

            Hypotension

            Tachycardia

            Dizziness

            Lightheadedness

            Blurred vision

            Flushing

            Nausea/vomiting

            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

            Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil)

            Riociguat; coadministration may cause hypotension

            Cautions

            Use caution in alcohol use, increased ICP (head trauma, cerebral hemorrhage-potential contraindication), hyperthyroidism, hypertrophic cardiomyopathy, increased IOP, hypotension, volume depletion, or low systolic BP

            Do not change brands unintentionally as not all are bioequivalent

            Treat drug-induced headache with aspirin or acetaminophen

            Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance

            Discontinue if blurred vision develops

            Do not apply with fingers; do not rub or massage

            Use supportive treatment in overdose

            Amplification of vasodilatory effects of nitroglycerin by sildenafil can result in severe hypotension; time course and dose dependence of this interaction not studied; appropriate supportive care has not been studied, but seems reasonable to treat this as a nitrate overdose, with elevation of extremities and with central volume expansion

            Benefits of transdermal nitroglycerin in patients with acute myocardial infarction or congestive heart failure not established; if one elects to use nitroglycerin in these conditions, use careful clinical or hemodynamic monitoring to avoid hazards of hypotension and tachycardia

            Severe hypotension, particularly with upright posture, may occur with even small doses; use drug with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive; hypotension induced by therapy may be accompanied by paradoxical bradycardia and increased angina pectoris

            Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy

            Effect of therapy on exercise tolerance, although still observable, may become somewhat blunted; in industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs; chest pains, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating existence of true physical dependence

            During nitrate-free intervals in some clinical trials, anginal attacks have been more easily provoked than before treatment, and patients have demonstrated hemodynamic rebound and decreased exercise tolerance; importance of these observations to routine, clinical use of transdermal nitroglycerin not known

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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 and converted to nitric oxide (NO) leading to activation of cGMP & vasodilation

            Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial O2 demand

            Also improves coronary collateral circulation

            Lower BP, increase HR, occasional paradoxical bradycardia

            Pharmacokinetics

            Half-Life elimination: 1-4 min

            Antianginal effects: 30 min

            Hemodynamic effects: Within 1 hr

            Duration antianginal effects: Up to 7 hr (topical)

            Hemodynamic effects: 3-6 hr

            Peak Plasma Time: 3-4 hr

            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

            BRAND FORM. UNIT PRICE PILL IMAGE
            nitroglycerin intravenous
            -
            50 mg/10 mL (5 mg/mL) vial
            Rectiv rectal
            -
            0.4 % (w/w) ointment
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.1 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.6 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.4 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.2 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.1 mg/hr transdermal system
            nitroglycerin transdermal
            -
            0.1 mg/hr transdermal system
            nitroglycerin oral
            -
            2.5 mg capsule
            nitroglycerin oral
            -
            9 mg capsule
            nitroglycerin oral
            -
            6.5 mg capsule
            Nitro-Dur transdermal
            -
            0.3 mg/hr transdermal system
            Nitro-Time oral
            -
            9 mg capsule
            Nitro-Time oral
            -
            6.5 mg capsule
            Nitro-Time oral
            -
            2.5 mg capsule
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin translingual
            -
            400 mcg/spray solution
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.3 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.3 mg tablet
            nitroglycerin sublingual
            -
            0.6 mg tablet
            nitroglycerin sublingual
            -
            0.3 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            nitroglycerin sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.6 mg tablet
            Nitrostat sublingual
            -
            0.4 mg tablet
            Nitrostat sublingual
            -
            0.3 mg tablet
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitro-Bid transdermal
            -
            2 % ointment
            Nitrolingual translingual
            -
            400 mcg/spray solution
            Nitromist translingual
            -
            400 mcg/spray aerosol

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Select a drug:
            Patient Education
            nitroglycerin intravenous

            NO MONOGRAPH AVAILABLE AT THIS TIME

            USES: Consult your pharmacist.

            HOW TO USE: Consult your pharmacist.

            SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Consult your pharmacist.

            DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: No monograph available at this time.

            MISSED DOSE: Consult your pharmacist.

            STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised July 2016. Copyright(c) 2023 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            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.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.