Sometimes you may have seen an elderly person wearing a small plaster on their chest, arm, or shoulder. This is not a plaster that is actually applied to the skin for pain. This is a special medication patch that doctors prescribe for people with heart disease, especially to prevent chest pain. Today, we will talk about this nitroglycerin patch.
What really happens with this medicine?
Simply put, this medicine called nitroglycerin prevents chest pain, a condition we call angina.
This is how it works: This medicine widens and relaxes the blood vessels in our body. This reduces the workload of the heart to pump blood. This gives the heart a rest, which helps control chest pain. This medicine belongs to a class of drugs called nitrates.
But this is not a medicine that will cure sudden chest pain. The doctor may have given you something like a pill to put under your tongue for that. This patch is just there to help you absorb the medicine throughout the day and prevent the pain from coming back.
What should I tell the doctor before using this patch?
It is very important that your doctor is aware of these things before prescribing this medicine to you. If you have any of the conditions listed below, be sure to tell them about it.
- If you have liver disease.
- If you have low blood pressure or low blood volume.
- If you have previously had a heart attack or heart failure.
- If you have an allergic reaction to nitroglycerin, the adhesives in the patch, other medications, foods, or dyes.
- If you are pregnant or trying to get pregnant.
- If you are a breastfeeding mother.
Based on this information, the doctor will decide whether this medication is right for you or not, or whether the dosage needs to be changed.
How exactly do you use this patch?
It is very important to know exactly how to use this.
- This patch is for external use only . Never put it in your mouth.
- Use it exactly as your doctor tells you. One patch contains the amount of medicine you need for a day.
- Typically, this should be left on for 12 to 14 hours, and then the patch should be removed for the next 10 to 12 hours. This patch-off period is very important. If it is not, the body may become accustomed to the medication and its effects may decrease.
- The patch should be applied to a clean, dry, and hairless area of the upper body, such as the chest, shoulders, back, or stomach. Do not apply to areas with wounds, broken skin, or scars.
- Don't apply it to the same spot every day. Change the spot every day. This will help reduce the risk of skin allergies.
- Never cut the patch or separate it into pieces.
- Do not stop using this medicine suddenly without your doctor's advice. Doing so may worsen your symptoms. If you do stop, do so as directed by your doctor, gradually reducing the dose.
What to do if the medication is too much?
If you think you have taken more medicine than you think, for example if you forget to take off a patch and put on another one, immediately call the National Poisons Information Centre at the Colombo National Hospital . Or go to the nearest hospital Emergency Department (ETU) immediately.
Other medications that should not be used with this medicine
While using this patch, taking certain other medications may cause severe reactions. Therefore, it is essential to tell your doctor about all medications you are taking.
| Type of medicine | What to pay particular attention to |
|---|---|
| Medications for sexual dysfunction | Taking medications like Sildenafil, Tadalafil, and Vardenafil with this patch is extremely dangerous . Blood pressure can drop very low. |
| Some medications for migraines | Medications such as ergotamine and dihydroergotamine (DHE). |
| Riociguat | This is a medicine for pulmonary hypertension. |
| Other medications for high blood pressure | Taking this patch with you can further lower your blood pressure. |
This list is not complete, so tell your doctor about every medication, vitamin, and traditional medicine you take.
What are the things to be careful about when using the patch?
- Medical tests: Go to the doctor at the scheduled time and get yourself checked. Measure your blood pressure and heart rate.
- Dizziness: This medicine may make you feel dizzy or lightheaded. So, get up slowly when getting up from a sitting position or out of bed. This condition can be made worse if you drink alcohol.
- Driving: Avoid driving or operating machinery until you know exactly how this medicine affects you.
- MRI scan: This is very important. If you are having an MRI scan, be sure to tell the staff that you are using a nitroglycerin patch. Some patches have an aluminum layer. This aluminum layer can heat up during the MRI scan and burn your skin. So you will need to remove the patch before the scan.
- If the patch comes off: If the patch comes off by itself, fold it in half (with the adhesive side facing in) and place it somewhere out of reach of children and animals. Then apply a new patch.
What are the possible side effects?
Like any medicine, this one can cause some side effects. Some are serious, some are common.
| Side effect | Description |
|---|---|
| Serious side effects that should be reported to your doctor immediately | |
| Allergic reactions | Skin rash, itching, swelling of the face, lips, tongue or throat. |
| Low blood pressure | Dizziness, fainting, blurred vision. |
| Slow heartbeat | Dizziness, fainting, difficulty breathing, feeling unusually tired. |
| Worsening angina | Pain, tightness, or a feeling of tightness in the chest, neck, back, or arms. |
| Symptoms of Methemoglobinemia | Headache, unusual weakness, shortness of breath, nausea, vomiting, rapid heartbeat, blue skin or lips. |
| Side effects that are usually not serious, but should be reported to the doctor if they persist | |
| Headache | This is common in the first few days of using the medication. |
| Dizziness | It can be felt especially when standing. |
| Flushing | The face and neck area becomes red and feels hot. |
Take-Home Message
- This patch is used to prevent chest pain (angina). It is not useful for sudden chest pain.
- Just as the doctor says, leave the patch on for the prescribed number of hours (usually 12-14 hours) and then remove it for the prescribed number of hours (10-12 hours). Be sure to follow this "patch-off" period .
- Never stop taking medication suddenly without asking your doctor.
- It is extremely dangerous to use this patch with medications for sexual dysfunction (such as Sildenafil).
- If you are scheduled to have an MRI scan, be sure to inform the MRI staff that you are using this patch.
- If you have any questions or concerns, talk to your doctor.
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