Nitroglycerin tablets 0.5 mg, 40 pcs. (Nytrohlytseryn)

Release form

Sublingual tablets.



packaging 40 pcs

Pharmacological action

Nitroglycerin is a peripheral vasodilator with a primary effect on venous vessels. Antianginal agent. The mechanism of action is associated with the release of the active substance of nitric oxide in the smooth muscles of the vessels. Nitric oxide causes activation of guanylate cyclase and increases the level of cGMP, which ultimately leads to relaxation of the smooth muscle. Under the influence of nitroglycerin, arterioles and precapillary sphincters relax to a lesser extent than large arteries and veins. This is partially due to reflex reactions, as well as a less intensive formation of nitric oxide from the molecules of the active substance in the walls of arterioles.

The effect of nitroglycerin is mainly associated with a decrease in myocardial oxygen demand due to a decrease in preload (expansion of peripheral veins and a decrease in blood flow to the right atrium) and afterload (decrease in OPS). Promotes the redistribution of coronary blood flow into the ischemic subendocardial regions of the myocardium. Increases exercise tolerance in patients with coronary heart disease, angina pectoris. In heart failure, it contributes to myocardial unloading, mainly due to a decrease in preload. Reduces pressure in the pulmonary circulation.

Indications

ischemic heart disease: exertional angina (treatment, prevention), vasospastic angina (Prinzmetal), unstable angina, coronary artery spasm during coronary angiography, acute coronary syndrome, acute myocardial infarction, acute left ventricular failure (cardiac asthma, interstitial and alveolar pulmonary edema), chronic heart failure, controlled arterial hypotension during surgical procedures, prevention of hypertensive reactions during endotracheal intubation, skin incisions, sternotomy, ocular occlusion of the arterial disc, ocular occlusion of the disc artery , functional cholecystopathy, acute pancreatitis, biliary colic, spastic intestinal dyskinesia.

Contraindications

Hypersensitivity, pronounced hypotension, collapse, myocardial infarction with low final diastolic pressure in the left ventricle and / or severe hypotension (systolic blood pressure below 90 mm Hg) or collapse, right heart attack, bradycardia less than 50 beats / min, primary pulmonary hypertension, cerebral hemorrhage, trauma scalp, increased intracranial pressure, cerebral ischemia, cardiac tamponade, toxic pulmonary edema, severe aortic stenosis, conditions accompanied by a decrease in the final diastolic pressure in the left ventricle (isolated mitral stenosis, con strictive pericarditis), angle-closure glaucoma, pregnancy, breast-feeding.

Special instructions

In the acute period of myocardial infarction and in the development of acute heart failure is prescribed under strict control of hemodynamics. Used with caution in aortic and mitral stenosis, in patients with hypovolemia and low syst. HELL (less than 90 mm Hg). With hypertrophic cardiomyopathy, it can cause an increase and / or aggravation of angina attacks. With prolonged uncontrolled intake of nitroglycerin, the appointment of high doses to patients with liver failure and children, the risk of methemoglobinemia increases, manifested by cyanosis and the appearance of a brown tint in the blood. In cases of the development of methemoglobinemia, the drug must be urgently discontinued and an antidote is introduced - methylthioninium chloride (Methylene blue). If it is necessary to continue using nitrates, it is mandatory to control the content of methemoglobin in the blood or replace nitrates with sydnonimines.

To reduce the risk of side effects, caution must be exercised while taking medications with pronounced antihypertensive and vasodilating properties. It is not recommended to take the drug while drinking alcohol in rooms with a high ambient temperature (bath, sauna, hot shower), and taking several tablets simultaneously or sequentially for a short period of time at the first dose.

Do not chew tablets and capsules in order to stop an attack of angina pectoris, as an excess amount of the drug from the destroyed microcapsules through the mucous membrane of the oral cavity can enter the systemic circulation. With the appearance of a headache and other unpleasant sensations in the head area, improvement is achieved by the administration of validol or drops of menthol sublingually. Often only the first doses are poorly tolerated, then the side effects subside.

When used simultaneously with heparin, it is necessary to increase the dose of heparin and strictly control the partially activated thromboplastin time. Use with caution in elderly patients. The appointment of buccal forms is not recommended for patients with aphthous stomatitis, gingivitis, periodontal and root system diseases, removable upper dentures.

Uncontrolled administration may lead to the development of tolerance, which is manifested in a decrease in the duration and severity of the effect with regular use or the need to increase the dose to achieve the same effect. With the regular use of prolonged forms of nitroglycerin, especially plasters and ointments, the drug is almost always present in the blood, so the risk of tolerance increases significantly. To prevent the occurrence of resistance, intermittent administration during the day is necessary, or co-administration of calcium antagonists, ACE inhibitors, or diuretics.

Composition

1 tablet contains 0.0005 g nitroglycerin

Dosage and administration of

Sublingual: tablets - 0.15-0.5 mg per dose, if necessary again after 5 minutes. In the case of acute left ventricular failure, 4 or more doses are possible for a short period.

Side effects of

From the nervous system and sensory organs: headache, dizziness, feeling of fullness of the head, weakness, motor anxiety, psychotic reactions, blurred vision, exacerbation of glaucoma.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): flushing, palpitations, hypotension, including orthostatic, collapse, methemoglobinemia.

From the digestive tract: dry mouth, nausea, vomiting, diarrhea,

From the skin: cyanosis, flushing of the skin.

Allergic reactions: itching and burning, allergic contact dermatitis (when using transdermal forms).

Other: hypothermia, sensation of heat, paradoxical effects - an attack of angina pectoris, ischemia, up to the development of myocardial infarction and sudden death, the development of tolerance.

Drug Interactions

Salicylates increase plasma nitroglycerin, barbiturates accelerate metabolism. Nitroglycerin reduces the pressor effect of adrenergic agonists, the anticoagulant effect of heparin (with iv administration). Antihypertensive, antiadrenergic drugs, vasodilators, sildenafil citrate, calcium antagonists, tricyclic antidepressants, MAO inhibitors, ethanol, quinidine and novocainamide enhance the hypotensive and systemic vasodilating effects. Methionine, N-acetylcysteine, ACE inhibitors and salicylates increase antianginal activity. Unitiol restores reduced sensitivity to nitroglycerin. Dihydroergotamine, m-anticholinergics, alpha-adrenergic agonists, histamine, pituitrin, corticosteroids, CNS and autonomic ganglia stimulants, bee and snake venoms, excessive insolation reduces vasodilator and antianginal effects.

Storage conditions

In a sheltered place, away from fire.

Expiration

2 years.

active substance

Nitroglycerin

lekarstvennaja tablet form



Indications

angina, prevention of acute myocardial infarction

Possible Product Names

Nitroglycerin Tab Sublingue 0, 5 mg N40 cont. Poly ind pack

Nitroglycerin tablets 0.5 mg, 40 pcs.



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