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硝酸イソソルビド40mg(フランドル®テープ)の特徴と服薬指導のポイント | いなかの薬剤師 " /> 循環器
硝酸イソソルビドテープ(フランドルテープ)の特徴と剥がれた時の対応
①硝酸イソソルビド40mg(フランドルテープ)の特徴
適応症
「狭心症、心筋梗塞(急性期を除く)、その他の虚血性心疾患 」
※最高血中濃度に達するには13時間程かかるので発作寛解には不適である。
→自分も頓服的に間違って使用していた患者と出会ったことがある
高齢者など特にしっかりと毎日貼り付けるものだと指導必要である
発作寛解には「ニトロペン®」や「ミオコール®スプレー」などを用いること(舌下投与)
副作用
比較的多い副作用
・接触性皮膚炎(5.15%)
・頭痛(0.98%)
・血圧低下(0.19%)
硝酸イソソルビドに「血管拡張作用」があるため
「頭痛」は血管性の拍動痛だと考えられる。
↓
通常、連続投与で1~2週間で消失する。
※初回の服薬指導時に伝えるべきだろう
添加剤~ミリスチン酸イソプロピル~
テープ剤としての製剤工夫
添加剤のミリスチン酸イソプロピルは、「軟化剤」である
↓
「粘着剤」を網目構造にする
↓
「柔軟性」が上がる
↓
皮膚の角質の剥離を抑制している(減らしている)
②剝がれた時の対応
フランドル®テープが剥がれた時どうする?
【剥がれた時】
もし剥がれてしまっても「貼り直しOK」!!!
下記のことがしっかりと確認されている
・貼り直しても「吸収」が保たれる
・「粘着性」が保たれる
※ツロブテロールテープ(ホクナリン®テープ)などは、
「粘着性」が保たれないため、新しいものを用いる
→「粘着性」がないということは、「吸収」がうまくされないということでもある
→剥がれないように絆創膏などを用いてNG・・・
メーカーとしてもはっきりとダメという返答がある
「吸収」されないと意味がないということ
※追加:ニトロダーム®TTSも再貼付不可
(一応皮膚障害がないなら貼付したまま入浴可能)
【汗をかいて剥がれた時の対策】
・汗を拭いて貼るか
・貼る場所を替えると良い
入浴時の工夫と注意点は?
【貼ったまま入浴する時】
心拍数と血管拡張作用が上昇する可能性があるため、
「ふらつき」、「転倒」に注意する
【入浴後に貼り直したい時 】
実際、入浴時人に見られたくない。心臓の薬を使用していることを隠したいという質問はある
「入浴後に貼り直してOK」 どうするの?剥がした後・・・ くちゃくちゃなると思う・・・
そうならないようにどうすればよいのか?
↓
対策の1つとして
ペットボトルやプラスチック製品に一時的に貼り付ける
※入浴後に貼り直すと一過性の血中濃度上昇があるが2時間ほどで元に戻る
参考資料
フランドル®テープ 添付文書 インタビューフォーム
トーアエイヨー株式会社 問い合わせ