Your doctor will likely ask you to take the patch off for 8 to 12 hours out of every 24 hours e. This "patch off" period may make the medicine more effective. Bathing, swimming, showering or exercising will usually not affect the patch if it has been correctly applied.
Use Transiderm-Nitro for as long as your doctor tells you to. Otherwise, you may not get relief from your attacks of angina. Try not to miss any doses and use the medicine even if you feel well. Do not stop using Transiderm-Nitro suddenly. Stopping this medicine suddenly may bring on attacks of angina, especially if you have been using it for several weeks or more. If you want to stop using it, your doctor will tell you how to do it gradually e. If it is almost time to apply your next patch, skip the one you missed and apply the next patch when you are meant to.
Otherwise, apply the patch as soon as you remember, respecting any prescribed patch-off period and then go back to using it as you would normally. Do not use a double dose to make up for the one that you missed.
This may increase the chance of you getting an unwanted side effect. If you have trouble remembering when to use your medicine, ask your pharmacist for some hints. Remove the patch. Immediately telephone your doctor or Poisons Information Centre telephone 13 11 26 , or go to Accident and Emergency at your nearest hospital, if you think that you or anyone else may have used too much Transiderm-Nitro.
Do this even if there are no signs of discomfort or poisoning. Keep telephone numbers for these places handy. Some of the symptoms of an overdose may include fast heartbeat, dizziness, light-headedness or fainting, especially when you get up quickly from a sitting or lying position. This is because your blood pressure is too low. Tell your doctor if you continue to have angina attacks or if they become more frequent or severe while you are using Transiderm-Nitro.
Keep a record of the number of attacks, when they happen and the possible cause for example, during exercise or during the period when the patch is off. This helps your doctor give you the best possible treatment.
If you become pregnant while taking Transiderm-Nitro, tell your doctor immediately. You doctor can discuss with you the risks of using it while you are pregnant. If you are about to be started on any new medicine, remind your doctor and pharmacist that you are using Transiderm-Nitro.
Tell any other doctor, dentist or pharmacist who treats you that you are using Transiderm-Nitro. Do not use Transiderm-Nitro to relieve an attack of angina. This medicine will not relieve an attack of angina once it has started. Your doctor will have given you other tablets or spray to use when you get attacks of angina. If you are using more than one patch, be careful to remember where you placed it and when you put it on. Some people using Transiderm Nitro will be using other medicines that are also patches.
Sometimes keeping track of these patches can be confusing. Be sure to pay particular attention to where you put each patch and what time each patch should be removed. Be careful driving, operating machinery or doing jobs that require you to be alert until you know how Transiderm-Nitro affects you. This medicine may cause dizziness, fainting or blurred vision in some people, especially when you first start to use it or if the dose is increased.
Be careful when drinking alcohol while you are using Transiderm-Nitro. Your blood pressure may drop, making you feel dizzy or faint. If this medicine makes you feel light-headed, dizzy or faint, be careful when getting up from a sitting or lying position.
You can usually prevent these symptoms by getting up slowly and flexing leg muscles and toes to get the blood flowing. When getting out of bed, dangle your legs over the side for a minute or two before standing up. Use extra care when exercising, driving or standing for long periods, especially in hot weather.
Be careful not to overdo physical activities when you start using Transiderm-Nitro. You may feel better when you start using it, but you will need time to improve your physical fitness.
This increases the blood supply to your heart, which gets more oxygen to your heart muscles and this reduces chest pain. By widening blood vessels GTN also makes it easier for your heart to pump blood around your body, so your heart muscles get more oxygen, reducing the risk of getting chest pain. Usually you will use GTN for a long time, possibly for the rest of your life.
GTN tablets go out of date expire 8 weeks after the bottle is opened. This is because the active ingredient can evaporate, which means the tablets will not work properly after that time. To make sure your tablets do not lose their strength before 8 weeks you need to:. Make sure you have a new supply of GTN to use after each pack expires. Always check the expiry date on the pack.
After 8 weeks, if you have any tablets left in the bottle, return that bottle to a pharmacy so they can dispose of it in the right way. There are no issues with taking GTN for a long time. Most people can take it with no problems. If you have been using GTN regularly and you stop taking it, your angina may get worse. This may increase your risk of a heart attack or stroke.
If you are taking GTN and are bothered by side effects, speak to your doctor. They may be able to change your dose or prescribe a different medicine instead. GTN is the only medicine available for fast relief of angina symptoms and to prevent pain before exercise or physical effort. There are other medicines that can be taken regularly to prevent angina attacks, including:.
If you're having surgery, you need to let the doctors know that you use GTN. They might ask you to stop using GTN for a short time before surgery. This is because some of the medicines used to make you sleep and not feel pain during surgery anaesthetic can make the side effects of GTN worse. You must tell the doctor or nurse if you are wearing a GTN patch if you are going to have certain types of tests and treatments including:.
Alcohol increases the blood pressure lowering effect of GTN, so it can make you feel dizzy, faint or sleepy. If this happens to you, it's best if you do not drink alcohol while you're taking GTN. If this does not happen to you, it's still better to not drink too much alcohol while you're taking GTN. You can eat normally while you are using GTN, but angina is a warning sign that you are at risk of serious problems such as heart attacks and strokes.
If you have angina, oral contraceptives are not recommended because they increase the risk of heart attack and stroke. There is no firm evidence that GTN affects fertility in men or women. If you are trying to get pregnant, talk to your doctor about using GTN. Some people with angina worry that having sex will trigger an angina attack, but the risk of this happening is low. It is as safe as other forms of exercise with similar levels of effort.
You cannot take medicines for erection problems if you are using GTN. These include:. If you have used one of these medicines, do not use or take GTN for at least 24 hours after sildenafil or vardenafil, and at least 48 hours after tadalafil. If you have an angina attack after using one of these medicines for erection problems, stop sexual activity immediately and rest. Do not use GTN. You might worry that exercising could trigger your symptoms or cause a heart attack, but the risk is low if you:.
GTN can make some people feel dizzy, sleepy or faint. If this happens to you, do not drive, ride a bike or use tools or machinery until you feel better.
Angina is a warning sign that you are at risk of serious problems such as heart attacks and strokes. Page last reviewed: 3 March Next review due: 3 March GTN is available on prescription. GTN skin patches or ointment are used every day to help prevent chest pain starting. You use the tablets or spray during an angina attack, or before any activity that's likely to cause an attack.
The most common side effects are headaches, feeling dizzy, weak, tired or sick nausea , and flushing. Tell your doctor or pharmacist if you have: ever had an allergic reaction to GTN or any other medicine in the past any recent brain or head injuries or problems including bleeding in your brain and raised pressure in your head ever had a stroke any heart problems other than angina , including a recent heart attack or heart failure low blood pressure hypotension anaemia glaucoma.
Stopping chest pain during an angina attack GTN tablets and spray are used under your tongue. Immediate action required: Call if:. You have taken 3 doses of GTN and: you're still in pain 5 minutes after your 3rd dose or your pain is getting worse you feel unwell These are signs that you may be having a heart attack.
Preventing chest pain before exercise or physical effort Tablets — put 1 tablet under your tongue before you start your activity. Preventing angina with a daily patch or ointment Patches — usually you put on 1 patch in the morning and take it off before you go to bed at night.
How to take GTN tablets Sit down. Put a tablet under your tongue and close your mouth. Allow the tablet to dissolve slowly — do not suck, chew or swallow it. Close the container — this is important, so your tablets do not lose their strength.
Rest for a while, then stand up slowly. How to use GTN spray Before using the spray for the first time, check it's working by pressing the button on the nozzle at the top of the bottle a few times, until a fine mist comes out.
Sit down. If you have not used your spray for over a week, do 1 spray into the air before you use it. Hold the nozzle in front of your mouth, with your finger on the button, and take a deep breath.
Open your mouth and lift your tongue up. Spray the GTN under your tongue by pressing once firmly — do not breathe in while you spray. Close your mouth immediately. Breathe through your nose keeping your mouth closed. Rest for a while before you stand up slowly. How to apply a GTN patch Sit down. Decide where to put your patch — choose an area of skin with no hair, or very little hair, so the patch sticks well.
Good places are the side of your chest, upper arm, shoulder or thigh. Put your patches in a different place each day of the week, and wait several days before using the same place again. Wash the area of skin and dry it completely — do not use talcum powder or anything else on your skin. Open the GTN packet with your fingers — do not use scissors because you might cut the patch.
Remove the patch from the packet. Peel the plastic backing off the patch and throw it away — do not touch the sticky surface of the patch with your fingers. Put the sticky side of the patch on the clean skin — press it down firmly and count to 5. Rub your finger round the edge of the patch to make sure no air or water can get in. How to apply ointment Sit down. Measure the dose — squeeze the right length of ointment onto the paper measure that comes in the packet.
Apply the ointment to your skin by holding the paper and pressing the ointment on to your chest, thigh, or arm until it is spread in a thin layer under the paper. Do not rub the ointment in. You can use surgical tape to stick the paper onto your skin.
Will my dose go up or down? What if I forget to take it? Never use a double dose to make up for a forgotten dose. What if I take too much? Urgent advice: Call now if:. In some people, the muscles and tendons pinch when they move their shoulder over and over again. The pinching can cause the rotator cuff to swell, break down and it may tear away from the bone - this is called rotator cuff disease or tendonitis.
In a lot of people, it is a normal part of ageing and they may not have symptoms. But many people with rotator cuff disease do have pain in their shoulder at some time that may not go away on its own. Topical glyceryl trinitrate also called nitroglycerin or nitroglycerine has been used to treat chest pain for many years, and has been proposed as a promising treatment for muscle and tendon injuries.
For treatment of soft tissue conditions glyceryl trinitrate is delivered topically, through the skin, using medicated patches. Headache was a common side effect in one trial and any benefits of treatment need to be balanced against the risk of headache. Further high quality research is needed to determine the effectiveness and safety of this new therapy. Rotator cuff disease is a common cause of shoulder pain.
Topical glyceryl trinitrate is a possible new treatment.
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