Nitro- Dur 0. 2mg/h; 0. Transdermal Patch - Summary of Product Characteristics (SPC)Nitro- Dur 0. Transdermal Patch. Glyceryl trinitrate 3. For excipients, see 6. For prophylaxis of angina pectoris either alone or in combination with other anti- anginal therapy. Adults, including elderly patients: The recommended initial dose is one 0. Nitro- Dur patch daily. In some patients dose titration to higher or lower doses may be necessary to achieve optimum therapeutic effect. Maximum dose: 1. 5 mg in 2. Nitro- Dur is suitable for continuous or intermittent use. Concomitant use can cause hypotension. NITRO-DUR- nitroglycerin patch Number of versions: 3 Published Date (What is this?) Version Files Oct 16, 2014 4 (current) download. What should I discuss with my healthcare provider before using nitroglycerin transdermal (Minitran, Nitrek, Nitro TD Patch-A, Nitro-Dur)? How should I use nitroglycerin transdermal (Minitran, Nitrek, Nitro TD Patch-A, Nitro-Dur)? Nitro-Dur Transdermal patch - 24 Hour drug summary. Find medication information including related drug classes, side effects, patient statistics and answers to frequently asked questions. Visit cvs.com for more details. Using Skin Patch Medicines Safely The Bottom Line Transdermal drugs release small amounts of drug into the blood stream over a long period of time. These 'skin patch' drugs include pain relievers, nicotine, hormones, and drugs to treat angina and motion. And whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins. Warnings. As with other nitrate preparations, when transferring the patient on long- term therapy to another form of medication, glyceryl trinitrate should be gradually withdrawn and overlapping treatment started. Nitro- dur is not indicated for the immediate treatment of acute angina attacks. Nitro- Dur patch must be removed before procedures such as cardioversion or DC defibrillation, to avoid possibility of electrical arcing, before diathermy. In cases of recent myocardial infarction or acute heart failure, treatment with Nitro- Dur should be carried out cautiously under strict medical surveillance and/or haemodynamic monitoring. Removal of the patch should be considered as part of the management of patients who develop significant hypotension. Precautions. The possibility of increased frequency of angina during patch- off periods should be considered. In such cases, the use of concomitant anti- anginal therapy is desirable. In some patients severe hypotension may occur particularly with upright posture, even with small doses of glyceryl trinitrate. Similarly, caution is called for in patients with hypoxaemia and ventilation/perfusion imbalance due to lung disease or ischaemic heart failure. In patients with alveolar hypoventilation, a vasoconstriction occurs within the lung to shift perfusion from areas of alveolar hypoxia to better ventilated regions of the lung (Euler- Liliestrand mechanism). Patients with angina pectoris, myocardial infarction, or cerebral ischaemia frequently suffer from abnormalities of the small airways (especially alveolar hypoxia). Under these circumstances vasoconstriction occurs within the lung to shift perfusion from areas of alveolar hypoxia to better ventilated regions of the lung. As a potent vasodilator, glyceryl trinitrate could reverse this protective vasoconstriction and thus result in increased perfusion of poorly ventilated areas, worsening of the ventilation/perfusion imbalance, and a further decrease in the arterial partial pressure of oxygen. Hypertrophic cardiomyopathy. Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy. Increased angina. The possibility of increased frequency of angina during patch- off periods should be considered. In such cases the use of concomitant anti- anginal therapy is desirable. Tolerance to sublingual glyceryl trinitrate As tolerance to glyceryl trinitrate patches develops, the effect of sublingual glyceryl trinitrate on exercise tolerance may be partially diminished. Interactions resulting in a concomitant use contraindicated. Concomitant administration of Nitro- Dur with phosphodiesterase inhibitors (e. Concomitant use potentiates the blood pressure- lowering effect of Nitro- Dur. Concomitant use of Nitro- Dur with soluble guanylate cyclase stimulators is contraindicated. Interactions to be considered. Concomitant treatment with calcium antagonists, ACE inhibitors, beta- blockers, diuretics, antihypertensives, tricyclic antidepressants and major tranquillisers may potentiate the blood- pressure- lowering effect of Nitro- Dur, as may alcohol. Concurrent administration of Nitro- Dur with dihydroergotamine may increase the bioavailability of dihydroergotamine. This warrants special attention in patients with coronary artery disease, because dihydroergotamine antagonises the effect of glyceryl trinitrate and may lead to coronary vasoconstriction. The non- steroidal anti- inflammatory drugs except acetyl salicylic acid may diminish the therapeutic response of Nitro- Dur. Concurrent administration of Nitro- Dur with amifostine and acetyl salicyclic acid may potentiate the blood pressure lowering effects of Nitro- Dur. Fertility. There is no data available on the effect of Nitro- Dur on fertility in humans. Pregnancy. Like any drug, Nitro- Dur should be employed with caution during pregnancy, especially in the first 3 months. Lactation. There is limited information on the excretion of the active substance in human or animal breast milk. A risk to the suckling child cannot be excluded. A decision must be made whether to discontinue breast- feeding or to discontinue/abstain from Nitro- Dur therapy taking into account the benefit of breast feeding for the child and the benefit of therapy for the woman. Nitro- Dur, especially at the start of treatment or dose adjustments, may impair the reactions, cause blurred vision, or might rarely cause orthostatic hypotension and dizziness (as well as exceptionally syncope after overdosing). Patients experiencing these effects should refrain from driving or using machines. Headache is the most common side- effect, especially at higher doses. These often regress after a few days despite the maintenance of therapy. If headaches persist during intermittent therapy, they should be treated with mild analgesics. Unresponsive headaches are an indication for reducing the dosage of glyceryl trinitrate or discontinuing treatment. A slight reflux- induced increase in heart rate can be avoided by resorting, if necessary, to combined treatment with a beta- blocker. Upon removal of the patch, any slight reddening of the skin will usually disappear within a few hours. The application site should be changed regularly to prevent local irritation. Because these reactions are reported voluntarily from a population of uncertain size, it is not possible to reliably estimate their frequency which therefore categorized as not known. Within each System- Organ Class, adverse drug reactions are presented in order of decreasing seriousness. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www. Increased intracranial pressure with associated cerebral symptoms may occur. Methaemoglobinaemia has also been reported following accidental overdose. Management. The nitrate effect of Nitro- Dur can be rapidly terminated simply by removing the system(s). Hypotension or collapse can be treated by elevation or, if necessary compression bandaging of the patient's legs. Glyceryl trinitrate, (as other organic nitrates), is a potent dilator of vascular smooth muscle.
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