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The following safety information outlines important considerations and potential risks related to the use of the nitroglycerin (Nitro-Dur) patch. Patients are advised to review these points and discuss any concerns with their healthcare provider.

• Low Blood Pressure: The Nitro-Dur patch may cause a significant drop in blood pressure, particularly when transitioning from sitting or lying down to standing. This can result in dizziness, fatigue, and lightheadedness, with increased risk for older adults and first-time users. To prevent falls, change positions slowly. Seek immediate medical attention if you experience symptoms such as irregular heartbeat, nausea, vomiting, weakness, vision changes, cold and clammy skin, or worsening chest pain. This risk is heightened in older adults, individuals with dehydration, or those taking other medications that lower blood pressure.

• Worsening Chest Pain: In rare instances, the Nitro-Dur patch can exacerbate chest pain linked to hypertrophic cardiomyopathy, a condition characterized by abnormally thick heart muscles. If you have this condition, consult your healthcare provider to determine if this medication is suitable for you. Emergency assistance should be sought if chest pain worsens after using the patch.

• Reduced Efficacy: Over time, the body may develop a tolerance to the Nitro-Dur patch, reducing its effectiveness in alleviating chest pain. To counteract this, your healthcare provider may recommend periodic breaks from the medication. Notify your provider if you experience chest pain or reduced exercise capability during these breaks.

• Headaches: Headaches are a common side effect, particularly when starting the Nitro-Dur patch or when changing positions. These may decrease or resolve as your body adjusts to the medication. If headaches persist and are troublesome, consult your healthcare provider for alternatives.

Contraindications:

The Nitro-Dur patch should not be used under the following conditions due to potential health risks. Please consult your healthcare provider if any of these apply:

• Concurrent use of PDE-5 inhibitors (e.g., sildenafil)
• Concurrent use of sGC stimulators (e.g., riociguat)
• Known allergy to nitrates or adhesives

When taking this medication, you may encounter some common side effects as your body adjusts. These include headache, dizziness, lightheadedness, nausea, and flushing. Headaches are common and might indicate that the medication is effective. Over-the-counter pain relievers like acetaminophen or aspirin can help, but if headaches persist or become severe, it is important to consult a healthcare provider.

To prevent dizziness and lightheadedness, it is advisable to rise slowly from sitting or lying positions. Though these side effects are generally mild, if they worsen, seek medical advice. Skin irritation has also been reported by some users; if this or any other non-serious side effects bother you, contact your healthcare provider.

Rare but serious side effects require immediate attention. These include fainting, a fast or irregular heartbeat, and dangerously low blood pressure, which may present as dizziness, pale skin, or feeling faint. In very rare cases, allergic reactions may occur, characterized by rash, severe dizziness, trouble breathing, or swelling of the face, tongue, or throat. If any of these occur, seek urgent medical care. Always inform your healthcare provider about any unusual side effects you experience.

Nitroglycerin (Nitro-Dur) patches can interact with several medications, so it is important to inform your doctor and pharmacist about all the drugs and supplements you use, including both prescription and over-the-counter options.

Certain medications, such as those used for erectile dysfunction or pulmonary hypertension, including avanafil, riociguat, sildenafil, tadalafil, and vardenafil, should not be used with Nitroglycerin (Nitro-Dur) due to potential interactions. Additionally, combining this drug with ergot alkaloids, like ergotamine used for migraine headaches, may also not be advisable.

In some instances, your healthcare provider might recommend using Nitroglycerin (Nitro-Dur) alongside other medications, such as alteplase, recombinant, acetylcysteine, apomorphine, aspirin, dihydroergotamine, and pancuronium. In such cases, adjustments to dosages or usage frequency may be necessary to manage side effects effectively.

Furthermore, Nitroglycerin (Nitro-Dur) may affect certain lab tests, such as those measuring blood cholesterol levels, leading to inaccurate results. Ensure all healthcare professionals involved in your care are aware that you are using this medication.