Managing tendonitis is always tricky. We know that exercise therapy is the best treatment for tendonitis. However, some people struggle with exercise and require other treatments. Generally, injections are effective in some cases of tendonitis but are risky and may cause nasty side effects. Shockwave therapy, collagen supplementation and a specific type of antibiotic also work for problematic tendonitis. GTN patch, a nitroglycerin patch for tendonitis, is an alternative to other treatments for most people with tendonitis. Is a GTN patch for tendonitis effective? Should you use a glyceryl trinitrate patch for tendonitis to help with exercise?
What are GTN patches?
GTN is also called nitroglycerin or glyceryl trinitrate. We use GTN patches to help heart disease patients. When a patch is placed on the skin on the arm or buttock, GTN is absorbed through the skin layer and opens blood vessels. This effect increases the blood supply to the heart muscle, helping heart disease patients. However, we also know that GTN patches heal tendons. Therefore, we place GTN patches on the skin over a painful tendon. In this way, GTN is absorbed through the skin and directly into the tendon.
How does GTN improve tendonitis?
We don’t know exactly. However, we think GTN increases levels of a hormone called nitric oxide. We suspect that nitric oxide stimulates collagen synthesis and blood flow, leading to tendon healing.
Recent studies show that applying GTN patches onto the skin over a painful tendon can lower tendon pain. Also, this recent systematic review investigating nitroglycerin patches for tendonitis found strong evidence of improvement in pain when using GTN patches with exercise.
However, a more recent systematic review of GTN patches cast doubts on the evidence for effectiveness and suggests that GTN has insignificant or borderline effectiveness in upper and lower limb tendonitis.
Overall, GTN have mixed evidence for use in tendonitis, although patches are relatively safe and non-invasive.
How do you use Nitroglycerin patches for tendonitis?
Firstly, a GTN patch is only helpful for tendons just under the skin. These tendons include
- Tennis elbow,
- Golfer’s elbow
- Achilles tendonitis,
- Patellar tendonitis,
- Peroneal tendonitis,
- Hand and wrist tendons.
- Rotator cuff tendonitis
The best evidence for GTN patches is in tennis elbow, Achilles tendonitis and rotator cuff tendonitis.
Secondly, only use a GTN patch with the brand name Deponit. Do not use other brands or a cheaper generic brand. Deponit is a matrix patch that does not leak out if you cut it. Conversely, the different brands will leak if you cut them, meaning you get more side effects and a less sustained impact.
Thirdly, you should start with a 1/4 patch to reduce the chances of side effects. Cut the patch in quarters and place a quarter patch onto the skin over the most tender part of the tendonitis. The unused patch should be discarded. Apply the patch in the morning and take it off at night. You need to have a patch break for at least 8 hours daily. The patch should stay on when you take a bath or shower. You can also exercise with the patch. If you tolerate a quarter patch after the 4th day, we suggest increasing the dose to half a patch. Then, if you have no headache after day 8, you can increase to a whole patch.
Nitroglycerin patches for tendonitis are prescription-only and prescribed by a doctor. We suggest using a patch for 2-3 months to help with an exercise program.
Summary for using Deponit patches:
- Cut the patch in quarters, using 1/4 to start. Discard any unused patch.
- Put 1/4 of a patch on the skin over the sore tendon.
- Leave the patch on during the day and take it off at night.
- After day 4, (if no headache) increase the dose to 1/2 patch.
- After day 8 (if no headache), increase the dose to a whole patch.
- If you experience a headache, take paracetamol or ibuprofen or reduce the patch dose.
- If you experience a skin rash, move the patch to a slightly different spot daily.
What are the side effects of a glyceryl trinitrate patch?
Generally, the most common side effect is a headache. About one in three people experience headaches. If you develop a headache, we suggest taking simple paracetamol. If this does not help, we recommend reducing the patch dose further. ( ½ patch to ¼ patch). Then, you can increase the patch dose to ½ or full as tolerated.
Skin rash is also a relatively common side effect. We suggest moving the GTN patch to a slightly different skin site if you develop a rash. For example, place the patch on the sore spot on day 1; set the patch in the 12 o’clock position within 1-2cm above the sore spot on day 2; then the 3 o’clock position on day 3; 6 o’clock on day 4, etc. The other option is to reduce the patch dose by using one-quarter of a patch.
Finally, you should avoid using the patch with medications to treat erectile dysfunction. Examples include Viagra and Cialis. If you are using these medications, we suggest you remove the patch. The effect of the nitroglycerin patches stops after 15-30 minutes.
How long until the GTN patches start working?
A GTN patch does not work immediately. Generally, we expect an effect after four weeks, sometimes up to six weeks.
How long should you use a nitroglycerin patch for tendonitis?
Generally, we recommend using nitroglycerin patches for 2-3 months.
However, in some cases, using the patch for more than three months and up to six months may be warranted.
Can you use other treatments with the glyceryl trinitrate patch?
Yes, we think using a nitroglycerin patch improves the effect of exercise therapy. You can also combine patches with other treatments, including shockwave therapy, collagen supplementation, or injections. Overall, combining GTN patches and other treatments with a comprehensive rehab program to improve outcomes is crucial.
Other frequently asked questions about nitroglycerin patches for tendonitis:
How long does it take for GTN patches to work for tendonitis?
Generally, you should notice an effect after two weeks, sometimes up to four weeks. If you don’t see an improvement after four weeks, the GTN patches are unlikely to help.
Do I need a prescription for glyceryl trinitrate patches for tendonitis?
Yes. You need to be prescribed GTN patches by doctors who understand this drug and know its potential interactions with other medical conditions. We suggest you avoid obtaining GTN patches from non-medically trained practitioners.
Are GTN patches addictive?
No. You don’t need to worry about addiction. There is no need to wean off this medication.
Are nitroglycerin patches a better option than tendon injections?
We think so. GTN patches have minimal side effects and are unlikely to worsen your tendon pain. Conversely, injections are invasive and unpredictable and may worsen your pain.
Can you use GTN patches if you have a history of chronic headaches or migraines?
Yes, but your chances of developing a headache or migraine increase. We suggest you start with a small dose—a quarter of a patch—and increase the dose to half a patch after four days and then a full patch after another eight days. Nevertheless, you may still have headache problems and may not tolerate the medication.
Final word from Sportdoctorlondon about the GTN patch for tendonitis
Overall, we like the option of a glyceryl trinitrate patch for tendonitis as it’s non-invasive and low-risk. Some people respond very well to patches. On the contrary, however, some do not tolerate patches well due to side effects. This finding mirrors the evidence, which shows mixed results. Nevertheless, glyceryl trinitrate patches are a good option for complex tendon cases that fail to respond to exercise therapy alone. Finally, you can only obtain GTN patches from a medical practitioner.
I read the referenced article (I’m a physician) but I could not find anything in the article that indicated that exercise in conjunction with the GTN patches is any more effective than without exercise. It logically makes sense that it would help though.
Yes you’re right – we don’t have evidence that combining patches with exercise is better than patches alone. I’d still recommend combining the two.
LM
Please get an article in a widely read medical journal. I had to do a lot of research to learn about the GTN patch. I presented the idea to my knee doctor and he said “oh I forgot about that, sure we can try it.”
please see this article open access study on GTN patches
https://bjsm.bmj.com/content/53/4/251