nitro patch + withdrawal or something else

[elrav]

I have been on the nitro-dur patch since Friday and forgot to take it yesterday.  I woke up this morning and now my bp is 185/110.  Can withdrawal of the nitro patch cause high blood pressure, even though I've only been taking it for three days now?

[kenkeith]

It appears you are doing everything right and the interval should be effective to prevent tolerance. Steady-state plasma concentrations of nitroglycerin are reached by about two hours after application of a patch and are maintained for the duration of wearing the system (observations have been limited to 24 hours). Upon removal of the patch, the plasma concentration declines with a half-life of about an hour.  If there were to be side effects, it seems it would be within hours.   Nitrates are not as effective (less strength) and have a longer half life so the same time constraints my not apply?!

Thanks for sharing your experience.

[elrav]

Thanks, Kenkeith, for your input too.  I understand what you are saying about the possibility of anxiety from missing a dose causing my bp to increase, but I actually wasn't even thinking that there could be any withdrawal symptoms from not wearing the patch, so I doubt that it is anxiety.  I simply took my bp this morning as I usually do, and lo' and  behold it was high.
I do have the break in treatment - I am to put the patch on at 8am and take it offf at 10pm, which I have done until yesterday.

[kenkeith]

ed is correct nitro dilates vessels.

I take a nitrate (isosorbide) for more than 6 years 3 times before going to gym for workout.  My blood pressure does not drop between intervals...in fact I was told to have intervals of nitrate free period.  It is true, nitro dilates the coronary vessels and prevents angina (chest pain).  The patch should only be worn for up to 12 to 14 hours a day, or as directed by your doctor, but continued use with no interruptions can cause a tolerance for drug....It is important to have a "nitrate-free" period of time each day for Nitroglycerin Patch to continue to work well and to decrease the risk of physical dependence.

Maybe the anxiety of missing a dose caused anxiety causing an increase in BP. "Some people who use Nitroglycerin Patch for a long time without a break may develop a physical need to continue taking it. This is known as physical DEPENDENCE. If you use Nitroglycerin Patch without a break and then suddenly stop using it, you may get WITHDRAWAL symptoms. No high bp but may include chest pain, heart attack, or possibly sudden death. Be sure to have a "nitrate-free" period of time each day; this may help prevent dependence and withdrawal problems".

Read more: http://www.drugs.com/cdi/nitroglycerin-patch.html#ixzz0xRS9k6y4

If you continue to have episodes of high blood pressure, you may want to contact your doctor.

[elrav]

Thanks for your input...my bp is slowly dropping now, so I guess the nitro is finally kicking in.

[ed34]

absolutely, the nitro patch is there to dilate your arteries, enabling more blood to flow. Once the Nitrates have reduced, your arteries will constrict again, raising blood pressure. Nitrates are very quick reacting which is why they are administered to heart attack victims.