Nitroderm TTS 5 (Nitroglycerin 5mg/24 hour [0.2mg/hour]) Patches

Nitroderm TTS general information

What is Nitroderm TTS used for?

Nitroderm TTS 5 (transdermal therapeutic system) is a transdermal patch that is used to treat angina pectoris to prevent or reduce the frequency of angina attacks, to relieve symptoms including chest pain or discomfort and breathlessness on exertion.  Angina is usually an indication of coronary heart disease (CHD) cause by clogged arteries in the heart (atherosclerosis), and angina attack can occur in response to activities or situation known to trigger angina, like physical effort, emotional stress or exposure to cold.  Nitroderm TTS 5 can be used as monotherapy or in conjunction with other anti-angina medications such as beta blockers or calcium antagonists.  Nitroderm TTS 5 is also used to treat congestive heart failure (CHF) in patients who are not responding adequately to conventional treatment with other medication for CHF.  Symptoms of CHF include swelling due to water retention in the tissues, particularly the feet and ankles, also the lungs, caused by weakened heart muscles so that the heart cannot pump blood efficiently, resulting in blood collecting in the smallest blood vessels, the capillaries, which become leaky.  Nitroderm TTS 5 is not intended for rapid and immediate relief of an acute angina attacks.  For acute angina attack you should use a rapid acting medication such as a sublingual nitrate (under the tongue) preparations. 

How does Nitroderm TTS work?

Nitroderm TTS 5 is a transdermal adhesive patch that contains nitroglycerine (glyceryl trinitrate) 50mg, a potent vasodilator used to relax and widen peripheral arteries and veins, to treat acute angina and congestive heart failure.  Angina is caused by insufficient blood to the heart due to a reduction of blood flow.  This is usually caused by narrowing of the arteries of the heart (coronary arteries) because of a blockage due to deposition of cholesterol in the vessel walls (atherosclerosis).  Nitroglycerine in Nitroderm TTS 5 is converted to nitric oxide in the blood vessel walls and this acts directly on the vascular smooth muscle in the blood vessel walls, causing them to dilate and widen (vasodilation).  This action reduces pooling of blood and resistance to blood flow in the peripheral veins which means that the heart does not need to work so hard to pump blood.  This reduces the workload on the heart and also the need for oxygen at rest and during exertion, thereby enhancing the capacity for exercise.  Nitroglycerine in Nitroderm TTS 5 also causes widening of the coronary arteries, which helps get more oxygen to the heart muscle and relieves symptoms of acute angina attack including pain in the chest, referred pain to the arms or neck and breathlessness on exertion.  The vasodilatory action of nitroglycerine in Nitroderm TTS 5 on peripheral veins reduces the left ventricular filling pressure of the heart, which improves the pumping efficiency of the heart and reduces congestion of the pulmonary vein that causes symptoms of congestive heart failure.  Nitroderm TTS 5 is a multilayer system that delivers nitroglycerine continuously through a release membrane, through the skin and directly into the blood. 

What does Nitroderm TTS contain?

Nitroderm TTS 5 contains the active ingredient nitroglycerine (25mg), used to treat angina pectoris and congestive heart failure.  The Nitroderm TTS 5 transdermal system delivers 5mg nitroglycerine directly into the blood circulation every 24 hours.  Nitroderm TTS 5 also contains silica aerogel, silicone oil 360 medical adhesive.

Treating angina with Nitroderm TTS

Nitroderm TTS 5 is a transdermal adhesive patch that contains nitroglycerine (glyceryl trinitrate) 50mg, a vasodilator that is used to treat angina and prevent angina attacks.  Angina is usually an indication of coronary heart disease (CHD) and is caused by insufficient blood to the heart due to a reduction of blood flow.  This is usually due to narrowing of the arteries of the heart (coronary arteries) because of a blockage caused by deposition of cholesterol in the vessel walls (atherosclerosis).  Spasm of the coronary arteries can also cause reduced blood flow to the heart and induce an angina attack.  Nitroglycerine in Nitroderm TTS 5 is converted to nitric oxide in the blood vessel walls and this acts directly on the vascular smooth muscle in the blood vessel walls, causing them to dilate and widen (vasodilation).  This action reduces pooling of blood and resistance to blood flow in the peripheral veins which means that the heart does not need to work so hard to pump blood.  This reduces the workload on the heart and also the need for oxygen at rest and during exertion, thereby enhancing the capacity for exercise.  Nitroglycerine in Nitroderm TTS 5 also causes widening of the coronary arteries, which helps get more oxygen to the heart muscle and relieves symptoms of acute angina attack including pain in the chest, referred pain to the arms or neck and breathlessness on exertion.  Nitroderm TTS 5 is a multilayer system that delivers nitroglycerine continuously through a release membrane, through the skin and directly into the blood.  Nitroderm TTS 5 is not intended for rapid and immediate relief of an acute angina attacks.  For acute angina attack you should use a rapid acting medication such as a sublingual nitrate (under the tongue) preparations. 

Nitroderm TTS for congestive heart failure

Nitroderm TTS 5 is a transdermal adhesive patch that contains nitroglycerine (glyceryl trinitrate) 50mg, a vasodilator that is used to treat congestive heart failure (CHF) in patients who are not responding adequately to conventional treatment with other medication.  CHF is caused by weakened heart muscles that the heart cannot pump blood efficiently, resulting in blood collecting in the smallest blood vessels, the capillaries, which become leaky resulting in swelling in the tissue due to water retention or oedema, particularly the feet and ankles, also the lungs.  Nitroglycerine in Nitroderm TTS 5 is converted to nitric oxide in the blood vessel walls and this acts directly on the vascular smooth muscle in the blood vessel walls, causing them to dilate and widen (vasodilation).  This action of nitroglycerine in Nitroderm TTS 5 reduces the left ventricular filling pressure of the heart, which improves the pumping efficiency of the heart and reduces congestion of the pulmonary vein that causes symptoms of congestive heart failure.  Nitroderm TTS 5 is a multilayer system that delivers nitroglycerine continuously through a release membrane, through the skin and directly into the blood. 

What are the side effects of Nitroderm TTS?

The most commonly reported side effects when taking Nitroderm TTS include headache, nausea, vomiting. 

When should Nitroderm TTS not be used?

You should not use Nitroderm TTS 5 if you:

• are allergic to nitroglycerine or any ingredients in Nitroderm TTS
• are pregnant or are breastfeeding, without discussion with your doctor
• have a condition associated with elevated intracranial pressure such as cerebral haemorrhage or head trauma
• have angina caused by hypertrophic obstructive cardiomyopathy, a disease of the heart muscle
• have cerebrovascular disease or lung disease
• have severe hypotension (low blood pressure), hypovolemia (low blood volume) or anaemia
• are taking medicines that interact with Nitroderm TTS, including: phosphodiesterase 5 inhibitors like sildenafil for erectile dysfunction, long-acting nitrate for angina, cardiovascular medications like calcium antagonists, ACE inhibitors, beta-blockers, diuretics, antihypertensives, dihydroergotamine for migraine, tricyclic antidepressants, major tranquillisers, alcohol

What medications interact with Nitroderm TTS?

Several medications interact with Nitroderm TTS 5 and should either not be taken while you are taking Nitroderm TTS or only after discussion and instruction from your doctor:

• Drugs that cause a serious reaction with Nitroderm TTS: other cardiovascular medications like calcium antagonists, ACE inhibitors, beta-blockers, diuretics, antihypertensives, tricyclic antidepressants, dihydroergotamine for migraine
• Drugs that affect Nitroderm TTS: other cardiovascular medications like calcium antagonists, ACE inhibitors, beta-blockers, diuretics, antihypertensives, tricyclic antidepressants
• Drugs that are affected by Nitroderm TTS: dihydroergotamine for migraine

How should Nitroderm TTS be used?

You should apply your Nitroderm TTS 5 patch once daily usually in the morning.  Although you can use your Nitroderm TTS 5 patches continually by removing one each morning and replacing with a new patch, you may be recommended by your doctor to have a patch free day of 8-12 hours out of every 24 hours, removing the patch overnight and applying another patch the next morning.  Before applying the patch, make sure the skin is clean, dry and free from oils or lotions; also make sure the skin is not cracked or broken and is not covered in hair.  Remove the protective liner and apply the patch to the chosen area of skin, such as the chest or upper arm, but not below the knees or elbows.  You should apply the patch to a different area of skin each day and allow 3-4 days before applying to the same area of skin.  You should continue to use your Nitroderm TTS 5 for as long as recommended by your doctor and do not stop using suddenly even if you feel better, as your condition will worsen.  You will be advised to stop using you Nitroderm TTS 5 patches gradually. 

How long should you use Nitroderm TTS?

You should continue to use your Nitroderm TTS 5 for as long as recommended by your doctor and do not stop using suddenly even if you feel better, as your condition will worsen.  You will be advised to stop using you Nitroderm TTS 5 patches gradually. 

Missed dose of Nitroderm TTS

If you miss application of Nitroderm TTS 5 apply it as soon as you remember, unless it is time to apply the next patch, then skip the missed patch.  Do not apply a double dose.

How should Nitroderm TTS be stored?

You should store your Nitroderm TTS 5 below 30°C in a cool dry place but do not freeze.