From the FDA Drug Label
To avoid development of tolerance to nitroglycerin, drug-free intervals of 10-12 hours are known to be sufficient; shorter intervals have not been well studied The recommended duration for leaving a nitroglycerin patch on in a patient with Non-ST-Elevation Myocardial Infarction (NSTEMI) is 12-14 hours, with a 10-12 hour drug-free interval to avoid development of tolerance 1.
- Key points:
- Drug-free intervals of 10-12 hours are sufficient to avoid tolerance
- Shorter intervals have not been well studied
- The patch should be removed for 10-12 hours to allow for a drug-free interval
From the Research
In NSTEMI, nitroglycerin patches should be left on for 12-14 hours per day with a 10-12 hour patch-free period to prevent nitrate tolerance, as supported by the most recent and highest quality study 2. The standard approach is to apply a new patch each morning (e.g., 8 AM) and remove it in the evening (e.g., 8-10 PM), allowing the overnight period to be nitrate-free.
- Common dosing starts at 0.2-0.4 mg/hour (corresponding to patches labeled as 5-10 mg/24 hours) and may be titrated up to 0.8 mg/hour based on symptoms and blood pressure response.
- When applying the patch, place it on clean, dry, hairless skin, typically on the chest, upper arm, or thigh, rotating sites with each application to prevent skin irritation.
- Avoid applying to areas with cuts, burns, or irritation.
- Monitor for side effects including headache, dizziness, and hypotension.
- The patch should be discontinued if systolic blood pressure falls below 90 mmHg. Nitroglycerin works by dilating coronary arteries, improving blood flow to ischemic myocardium, and reducing cardiac workload through decreased preload and afterload, which helps relieve angina symptoms in NSTEMI patients. Although other studies suggest similar recommendations 3, 4, 5, 6, the most recent study 2 provides the strongest evidence for the recommended duration of nitroglycerin patch use in NSTEMI patients.