What Nitroderm TTS is used for
Nitroderm TTS is an adhesive patch that delivers a product called nitroglycerin through the skin and into the bloodstream.
Nitroderm TTS is used to prevent or reduce the frequency of angina attacks (chest pain or discomfort). .
Nitroderm TTS is also used as a supplementary product for the treatment of patients suffering from heart failure who do not respond adequately to conventional therapy.
Nitroderm TTS belongs to a group of medicines called nitrates. Nitrates work by widening blood vessels, letting more blood and oxygen reach the heart.
Ask your doctor if you have any questions about why this product has been prescribed for you.
Your doctor may have prescribed it for another purpose.
There is not enough information to recommend this product for children.
Before you use Nitroderm TTS
When you must not use it
Do not use Nitroderm TTS if you are allergic to:
• nitroglycerin (the active ingredient) or any of the other ingredients of Nitroderm TTS listed at the end of this leaflet
• any other product or food containing nitrates or nitrites
Some of the symptoms of an allergic reaction may include shortness of breath, wheezing or difficulty breathing; swelling of the face, lips, tongue or other parts of the body; rash, itching or hives on the skin.
Do not use Nitroderm TTS if you have any of the following medical conditions:
• severe anaemia
• glaucoma or raised pressure in the eye from any cause
• increased pressure in the head from any cause (stroke, tumour, head injury)
• disease in the valves of your heart or inflammation of your heart
If you are not sure whether any of the above medical conditions apply to you, your doctor can advise you.
Do not use Nitroderm TTS if you are taking Viagra or Levitra, medicines used for impotence in men.
If you use Viagra or Levitra together with Nitroderm TTS, your blood pressure may fall to a dangerously low level.
Do not use Nitroderm TTS after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering.
In that case, return it to your pharmacist.
Before you start to use it
Tell your doctor if you have any of the following medical conditions:
• recent heart attack, stroke or head injury
• heart problems or a blood vessel disorder other than angina
• low blood pressure
• problems with your lungs
• problems with your liver
Your doctor may want to take special precautions if you have any of the above conditions.
Tell your doctor if you are pregnant or breast-feeding.
This product may affect your baby if you use it while you are pregnant or breast-feeding. Your doctor can discuss with you the risks and benefits involved.
Tell your doctor if you are allergic to any other medicines, foods, dyes or preservatives.
Your doctor will want to know if you are prone to allergies.
Taking other medicines
Tell your doctor or pharmacist if you are taking any other medicines, including any that you buy without a prescription from a product, supermarket or health food shop.
Some medicines and Nitroderm TTS may interfere with each other. These include:
• Viagra or Levitra, medicines used for impotence in men
• other medicines for angina
• medicines for high blood pressure or heart problems
• diuretic medicines, also called water or fluid tablets
• some medicines used to treat depression called tricyclic antidepressants
• medicines for mental disorders
• dihydroergotamine, a product for migraine
• acetylsalicylic acid (aspirin)
• medicines used to treat inflammation called non-steroidal anti-inflammatory drugs (NSAIDs)
You may need to take different amounts of your medicines or to take different medicines while you are using Nitroderm TTS. Your doctor and pharmacist have more information.
If you have not told your doctor about any of these things, tell him/her before you start using this product.
How to use Nitroderm TTS
Follow all directions given to you by your doctor and pharmacist carefully.
They may differ from the information contained in this leaflet.
If you do not understand the instructions on the label, ask your doctor or pharmacist for help.
How much to use
Your doctor may start your treatment with one Nitroderm TTS 5 patch each day for several days and then change to the larger Nitroderm TTS 10 patch. The usual dose for most people is one Nitroderm TTS 10 patch each day, although some people may need more or less.
When to use it
You will normally apply a patch once each day, usually in the morning.
Your doctor will likely ask you to take the patch off for 8 to 12 hours out of every 24 hours (e.g. take it off at bedtime and put a new one on when you wake up in the morning). This "patch off" period may make the product more effective.
How to apply the patch
A leaflet in the cardboard carton contains pictures showing how to apply the patch properly.
Follow these steps to apply a patch to your skin.
1. Choose an area of skin:
• The best place is your chest but you may use any area except below your knees or elbows.
• Choose an area of skin that has no sores, cuts or rashes.
• If the skin is very hairy, you can clip the hair (do not shave it) so that the patch sticks well and won't be hard to remove.
• Use a different area of skin each day. Wait several days before using the same area again.
2. Make sure the skin is clean, cool, dry and free from creams, lotions or oils:
• You may need to wash the area with soap and water and dry it completely.
• If your skin is very oily, you can use methylated spirits to clean it, then dry it completely.
• After a shower or bath, wait a few minutes before applying the patch to make sure your skin is completely cool and dry.
• You may use body lotion or bath oil after the patch has been applied.
3. Open the sachet that contains the patch:
• Tear open the sachet at the notch and remove the patch.
• Do not use scissors because you may accidentally cut the patch and the product may leak out.
• Any air bubbles on the patch are not important.
4. Remove the protective liner from the sticky side of the patch:
• Pick up the patch with the tab upwards and the white liner facing you.
• Firmly bend the tab forward with your thumb.
• Use both thumbs to peel off the protective liner, starting at the tab. Do not touch the sticky surface of the patch. • Throw the liner away.
5. Apply the patch to the skin as soon as you have removed the liner:
• Press the sticky side of the patch to the area of skin you have chosen so that the tan coloured side is showing.
• Press the patch firmly in place with the palm of your hand for 10 to 20 seconds. The patch needs the pressure and heat of your hand to stick well.
• Check that the patch has stuck by running your finger around the edge. Do not try to lift the edge of the patch to see if it has stuck.
How to remove the patch
• Use the little tab to pull the patch away from your skin.
• Fold the old patch in half with the sticky side inwards.
• Throw the old patch away safely out of the reach of children. The patch still contains some leftover product that could harm a child.
• Remove any stickiness from the skin with soap and water or methylated spirits.
If the patch falls off
• Throw the patch away.
• Apply a new patch to a different area of clean, dry skin.
• Change the patch at the next time that you would normally change it.
Bathing, swimming, showering or exercising will usually not affect the patch if it has been correctly applied.
If the patch irritates your skin
• Check that water has not gotten under the patch. If it has, remove the patch and apply a new one to a different area.
• Try a less sensitive area, for example your upper arm.
• Use a new area of skin for each patch. Do not use the same area of skin for at least a week.
• You can use a mild cream on the sore area once the patch has been removed.
How long to use it
Use Nitroderm TTS 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 product even if you feel well.
Do not stop using Nitroderm TTS suddenly.
Stopping this product 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.g. over 4 to 6 weeks) to avoid making your angina worse.
If you forget to use it
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, 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 product, ask your pharmacist for some hints.
If you use too much (overdose)
Remove the patch. Immediately telephone your doctor or the National Poisons Information Centre, Dunedin (telephone 0800 POISON or 0800 764 766), or go to the Accident and Emergency Department at your nearest hospital, if you think that you or anyone else may have used too much Nitrode
Things you must not do
Do not use Nitroderm TTS to relieve an attack of angina.
This product 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.
Do not give this product to anyone else, even if their condition seems similar to yours.
Do not take it to treat any other complaints unless your doctor tells you to.
Things to be careful of
Be careful driving, operating machinery or doing jobs that require you to be alert until you know how Nitroderm TTS affects you.
This product 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 Nitroderm TTS.
Your blood pressure may drop, making you feel dizzy or faint.
If this product 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 Nitroderm TTS.
You may feel better when you start using it, but you will need time to improve your physical fitness.
Tell your doctor or pharmacist as soon as possible if you do not feel well while you are using Nitroderm TTS.
All medicines can have side effects. Sometimes they are serious, but most of the time they are not. You may need medical treatment if you get some of the side effects.
If you are over 65 years old, you should be especially careful and report any side effects promptly to your doctor.
As people grow older, they are more likely to get side effects from medicines.
Do not be alarmed by these lists of possible side effects. You may not experience any of them.
Ask your doctor or pharmacist to answer any questions you may have.
Tell your doctor if you notice any of the following and they worry you:
• headache, which usually goes away after taking a mild pain reliever such as paracetamol
• dizziness or lightheadedness, sometimes accompanied by a fast heart beat, especially when getting up suddenly
• itching or burning under the patch
• reddening of the skin after the patch has been taken off
• flushing of the face
• nausea (feeling sick) or vomiting
Tell your doctor immediately or go to the Accident and Emergency Department at your nearest hospital if you notice any of the following:
• signs of allergy such as rash, itching or hives on the skin; swelling of the face, lips, tongue or other parts of the body; shortness of breath, wheezing or troubled breathing
• severe redness, swelling or blisters under the patch
• chest pains that are not relieved by taking your usual product for treating an angina attack
• severe dizziness or fainting
• severe or persistent headache
Tell your doctor if you notice anything else that is making you feel unwell.
Some people may have other side effects not yet known or mentioned in this leaflet.
After using Nitroderm TTS
• Keep your product in the original container until it is time to use it.
• Store it in a cool dry place but not in the freezer.
• Do not store Nitroderm TTS or any other product in the bathroom or near a sink.
• Do not leave it in the car or on window sills.
Keep the patches where children cannot reach them.
A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.
• Fold used patches in half with the sticky side inwards.
• Dispose of the patches where children cannot reach them.
Used patches still contain some nitroglycerin that could harm a child.
If your doctor tells you to stop using Nitroderm TTS or the expiry date has passed, ask your pharmacist what to do with any product that is left over.