Nitroglycerin transdermal patches are contraindicated in patients with hypersensitivity to organic nitrates or patch adhesives, recent use of PDE-5 inhibitors (e.g., sildenafil, tadalafil), or concomitant use with riociguat. Additional cautions include avoiding abrupt position changes, limiting alcohol, and monitoring in conditions like hypotension or hypertrophic cardiomyopathy. The patch is not for acute angina relief and requires careful use in elderly or volume-depleted patients.
Key Points Explained:
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Hypersensitivity Reactions
- Contraindicated in patients allergic to organic nitrates or patch adhesives. Hypersensitivity can manifest as skin irritation, rash, or systemic allergic reactions.
- Example: Patients with a history of contact dermatitis from medical adhesives should avoid Nitroglycerin Transdermal Patch.
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Drug Interactions
- PDE-5 Inhibitors (e.g., sildenafil, tadalafil): Concurrent use can cause severe hypotension due to synergistic vasodilation. A washout period of several days is required before patch application.
- Riociguat: This guanylate cyclase stimulator amplifies nitrate effects, risking life-threatening blood pressure drops.
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Clinical Conditions Requiring Caution
- Hypotension/Risk of Falls: Elderly or volume-depleted patients are prone to dizziness or syncope. Advise slow position changes and hydration.
- Cardiovascular Issues: Avoid in hypertrophic cardiomyopathy (may worsen angina) and severe aortic stenosis.
- Neurologic/Endocrine: Use cautiously in increased intracranial pressure (ICP) or hyperthyroidism (exacerbates tachycardia).
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Practical Safety Measures
- Alcohol: Potentiates hypotensive effects; recommend moderation.
- Defibrillation: Remove patches before cardioversion to prevent burns.
- Disposal: Discarded patches retain active drug; keep away from children/pets.
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Therapeutic Limitations
- Not for acute angina (onset too slow); use sublingual nitroglycerin instead.
- Unproven benefits in acute myocardial infarction or heart failure.
Have you considered how these contraindications might influence prescribing decisions in patients with multiple comorbidities? The patch’s convenience must be weighed against risks, especially in complex cases where polypharmacy or frailty is a concern.
Summary Table:
| Contraindication/Caution | Details |
|---|---|
| Hypersensitivity | Avoid if allergic to nitrates or adhesives (e.g., skin rash, systemic reactions). |
| PDE-5 Inhibitors (e.g., Viagra) | Severe hypotension risk; require 24–48h washout. |
| Riociguat | Life-threatening BP drops; absolute contraindication. |
| Hypotension/Falls | Monitor elderly/volume-depleted patients; advise slow position changes. |
| Alcohol Use | Potentiates hypotension; recommend moderation. |
| Acute Angina | Not for emergency relief; use sublingual nitroglycerin instead. |
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