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Prevention:Initial: Apply 0.5 inch (7.5mg) bid, once in the am and 6 hrs laterTitrate: May increase to 1 inch bid, then to 2 inches bidShould have 10-12 hrs nitrate-free period
Place applicator on flat surface, printed side downSqueeze necessary amount from tube onto applicatorPlace applicator (oint side down) on desired area of skin, spread oint, and tape into place
Oint: 2% [1g, foilpac; 30g, 60g, tube]
Use careful clinical or hemodynamic monitoring to avoid the hazards of hypotension and tachycardia if treating patients with acute myocardial infarction (AMI) or congestive heart failure (CHF). Severe hypotension, particularly with upright posture, may occur with even small doses; caution with volume depletion or hypotension. Nitroglycerin-induced hypotension may be accompanied by paradoxical bradycardia and increased angina pectoris. May aggravate the angina caused by hypertrophic cardiomyopathy. Tolerance and physical dependence may occur.
Amplification of the vasodilatory effects by sildenafil can result in severe hypotension; treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion. Vasodilating effects may be additive with those of other vasodilators (eg, alcohol). Marked symptomatic orthostatic hypotension reported when used with calcium channel blockers; dose adjustments of either drug may be necessary.
Category C, caution in nursing.
Nitrate vasodilator; relaxes vascular smooth muscle and consequently dilates peripheral arteries and veins, especially the latter.
Distribution: Vd=3L/kg. Metabolism: Inorganic nitrate and 1,2- and 1,3-dinitroglycerols (metabolites). Elimination: T1/2=3 min.
Assess for hypersensitivity to organic nitrates, AMI, CHF, volume depletion, hypotension, angina caused by hypertrophic cardiomyopathy, pregnancy/nursing status, and possible drug interactions.
Monitor for hypotension, paradoxical bradycardia, increased/aggravated angina pectoris, tolerance, physical dependence, and other adverse reactions. Perform careful clinical or hemodynamic monitoring in patients with AMI or CHF.
Inform that daily headaches sometimes accompany treatment and that the headaches are a marker of the activity of the drug; advise to resist the temptation to avoid headaches by altering the schedule of treatment, since loss of headache is likely to be associated with simultaneous loss of antianginal efficacy. Inform that therapy may be associated with lightheadedness on standing, especially just after rising from a recumbent or seated position; counsel that lightheadedness may be more frequent in patients who have consumed alcohol.