Nitrates Topical (Systemic)

Proper Use of This Medicine

Use nitroglycerin exactly as directed by your doctor . It will work only if applied correctly.

The ointment and transdermal forms of nitroglycerin are used to reduce the number of angina attacks. They will not relieve an attack that has already started because they work too slowly. Check with your doctor if you need a fast-acting medicine to relieve the pain of an angina attack.

This medicine usually comes with patient instructions. Read them carefully before using this medicine .

For patients using the ointment form of this medicine:

• Before applying a new dose of ointment, remove any ointment remaining on the skin from a previous dose. This will allow the fresh ointment to release the nitroglycerin properly.
• This medicine comes with dose-measuring papers. Use them to measure the length of ointment squeezed from the tube and to apply the ointment to the skin. Do not rub or massage the ointment into the skin; just spread in a thin, even layer, covering an area of the same size each time it is applied .
• Apply the ointment to skin that has little or no hair.
• Apply each dose of ointment to a different area of skin to prevent irritation or other skin problems.
• If your doctor has ordered an occlusive dressing (airtight covering, such as kitchen plastic wrap) to be applied over this medicine, make sure you know how to apply it. Since occlusive dressings increase the amount of medicine absorbed through the skin and the possibility of side effects, use them only as directed. If you have any questions about this, check with your health care professional.

For patients using the transdermal (stick-on patch) system :

• Do not try to trim or cut the adhesive patch to adjust the dosage. Check with your doctor if you think the medicine is not working as it should.
• Apply the patch to a clean, dry skin area with little or no hair and free of scars, cuts, or irritation. Remove the previous patch before applying a new one.
• Apply a new patch if the first one becomes loose or falls off.
• Apply each dose to a different area of skin to prevent skin irritation or other problems.

Dosing - The dose of nitroglycerin will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of nitrates. If your dose is different, do not change it unless your doctor tells you to do so.

For nitroglycerin
• For angina (chest pain):
  • For ointment dosage form:
    • Adults - 15 to 30 milligrams (mg) (about one to two inches of ointment squeezed from tube) every six to eight hours.
    • Children - Use and dose must be determined by your doctor.
  • For transdermal system (skin patch) dosage form:
    • Adults - Apply one transdermal dosage system (skin patch) to intact skin once a day. The patch is usually left on for 12 to 14 hours a day and then taken off. Follow your doctor's instructions for when to put on and take off the skin patch.
    • Children - Use and dose must be determined by your doctor.

Missed dose -

• For patients using the ointment form of this medicine: If you miss a dose of this medicine, apply it as soon as possible unless the next scheduled dose is within 2 hours. Then go back to your regular dosing schedule. Do not increase the amount used.
• For patients using the transdermal (stick-on patch) system : If you miss a dose of this medicine, apply it as soon as possible. Then go back to your regular dosing schedule.

Storage -

• To store the ointment form of this medicine:
  • Keep out of the reach of children.
  • Store the tube of nitroglycerin ointment in a cool place and keep it tightly closed.
  • Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
• To store the transdermal (stick-on patch) system :
  • Keep out of the reach of children.
  • Store away from heat and direct light.
  • Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
  • Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.