Nitroglycerin paste, often called nitro paste, is a medication prescribed to help prevent episodes of chest pain (angina), typically caused by coronary artery disease. The paste is a topical formulation containing nitroglycerin, a vasodilator that relaxes blood vessels to increase blood flow and oxygen to the heart muscle, reducing its workload. This medication is absorbed directly through the skin into the bloodstream, offering a sustained-release effect that helps manage angina over several hours. Following the precise application instructions from your healthcare provider is important to ensure both safety and effectiveness.
Essential Preparations Before Application
Before application, gather all necessary items: the nitroglycerin paste tube, dose-measuring application papers, an adhesive covering (tape or plastic wrap), and disposable gloves. Keep mild soap and water readily available for hand hygiene before and after the procedure.
Select an appropriate application site, which should be a clean, dry area of skin with little hair, such as the chest, back, upper arm, or thigh. Avoid areas that are scarred, irritated, cut, or calloused, as this affects medication absorption. To prevent skin irritation and drug tolerance, rotate the application site daily, never applying the new dose to the previous spot.
Gently clean the chosen area with soap and water if necessary, then pat the skin completely dry immediately before application. If the area has hair, trim it carefully, rather than shaving, to avoid creating micro-abrasions that could increase absorption. This preparation ensures the medication is absorbed consistently.
Step-by-Step Application Technique
Begin by putting on disposable gloves to protect yourself from accidentally absorbing the medication. Use the dose-measuring paper supplied with the tube to ensure the correct dosage. Squeeze the prescribed amount of paste onto the non-printed side of the paper, using the imprinted scale (typically measured in inches, as specified by your prescription).
Immediately use the paper itself to apply the paste to the chosen skin area. Spread the measured paste lightly and thinly over the designated area, which is usually a square area of about 2 by 3 inches or 3 by 3 inches. Do not rub or massage the paste into the skin, as this increases the absorption rate and interferes with the intended sustained-release action.
Secure the application paper and medication to the skin using the provided adhesive dressing or plastic wrap and tape. This covering prevents the paste from rubbing off onto clothing or others and ensures the medication stays in place. If an occlusive dressing is specified, use it, as this may increase absorption. After covering, remove your gloves and immediately wash your hands thoroughly with soap and water to remove any residual medication.
Safe Handling, Removal, and Disposal
The nitroglycerin paste is typically worn for a set period, often 12 to 14 hours, allowing for a daily nitrate-free interval. This interval helps prevent the body from developing drug tolerance.
When it is time for removal, put on a new pair of disposable gloves. Gently peel off the adhesive cover and the application paper containing the residual paste. Use a clean cloth or tissue to wipe any excess residue from the application site. Wash the skin area with soap and water to ensure no active medication remains. If irritation persists, contact your healthcare provider.
For disposal, fold the used application paper and cover so the residual paste is contained entirely within the folded material, medication side inward. Even used paste contains enough active ingredient to be harmful to others. Dispose of the contained material safely in a trash receptacle, ensuring it is out of reach of children and pets, as accidental exposure can cause severe reactions.
While headaches are a common side effect, seek immediate medical advice if you experience severe dizziness, fainting, or a sudden drop in blood pressure after application. Accidental exposure to the paste by another person, especially a child, is dangerous and requires immediate medical attention due to the risk of severe hypotension. Always store the tube with the cap tightly screwed on, away from heat and moisture, and out of the reach of children.