Nitroglycerine

General characteristics. Structure:

Active ingredient: 0,4 mg of nitroglycerine.

Excipient: ethanol of 95% (in the form of 1% of solution).

Pharmacological properties:

Pharmacodynamics. Nitroglycerine - organic nitrogen-containing compound with preferential venodilatiruyushchy action. Effects of nitroglycerine are caused by its ability to release the nitrogen oxide which is natural эндотелиальньгм the running-down factor from the molecule. Nitrogen oxide increases intracellular concentration of a cyclic guanozinmonofosfataza that prevents penetration of calcium ions into smooth muscle cells and causes their relaxation. Relaxation of unstriated muscles of a vascular wall causes vasodilatation that reduces venous return to heart (preloading) and resistance of a big circle of blood circulation (afterload). It reduces cardiac performance and the need of a myocardium for oxygen. Expansion of coronary vessels improves a coronary blood stream and promotes its redistribution in the area with reduced blood circulation that increases delivery of oxygen in a myocardium.

Reduction of venous return leads to filling pressure decrease, improvement of blood supply of subendocardial layers, pressure decrease in a small circle of blood circulation and regression of symptoms at a fluid lungs. Nitroglycerine exerts the central braking impact on a sympathetic tone of vessels, oppressing a vascular component of formation of a pain syndrome. Nitroglycerine also relaxes smooth muscle cells of bronchial tubes, urinary tract, a gall bladder, bilious channels, a gullet, a small and large intestine, and also their sphincters. Effect of Nitroglycerine at sublingual use begins quickly, the effect develops within 1-1.5 minutes and about 30 minutes last.

Indications to use:

Stenocardia (stopping and prevention of attacks, including before an exercise stress).

Route of administration and doses:

Drug is recommended to be used on doctor's orders in order to avoid complications. At the first signs of an attack of stenocardia, depending on weight to enter Nitroglycerine as follows: it is desirable in situation "sitting" 0.4-0.8 mg (1-2 doses) by pressing the dosing valve put on or under language, at breath holding with intervals in 30 sec.; after that to close a mouth for several seconds. If necessary - repeated introduction, but no more than 1.2 mg (3 doses) within 15 minutes.

If necessary apply to stopping of an attack of stenocardia repeatedly with 5-minutny intervals.

If after reception of three measured doses within 15 minutes of simplification did not come, consultation of the doctor is necessary.

With the preventive purpose 1 dose in 5-10 minutes prior to estimated loading or a stress is entered.

Before the use not to stir up, hold packaging when spraying vertically, directly before itself. After each spraying of companies to close, at once not to swallow.

The highest single dose: 3 doses. Each pressing the dosing valve releases one dose (0.4 mg of nitroglycerine) in the form of spray from a cylinder. Not to inhale spray at all. Before the first use of a cylinder it is necessary to fill a dispensing pump by removal of a protective cap and pressing the dosing valve several times before emergence of spray. After long non-use of a cylinder there can be a need for a pump refill.

Features of use:

Use at pregnancy and feeding by a breast. Use of Nitroglycerine at pregnancy and during breastfeeding demands careful comparison of risk and advantage and has to is carried out under strict medical observation.

Release of nitroglycerine in breast milk is not established.

Use for children. It is contraindicated to children up to 18 years.

To apply with care at orthostatic hypotension, a hemorrhagic stroke, a heavy renal and/or liver failure, a thyrotoxicosis, an alcohol abuse, epilepsy, a craniocereberal injury, closed-angle glaucoma (risk of increase in intraocular pressure), migraine, heavy anemia.

The special attention and observation is required at therapy of the patients inclined to development of orthostatic hypotension, and also in the presence of the increased intracranial pressure. Sensitivity to nitrates at different patients can strongly vary that should be considered at the choice of a dosage. Increase in a dose can cause tolerance to drug (accustoming). Drug contains alcohol that is important for patients with abnormal liver functions, an alcohol abuse, epilepsy, a craniocereberal injury and other diseases of the central nervous system, and also to pregnant women and children.

Nitroglycerine can strengthen effects of other drugs. If the illegibility of sight or dryness in a mouth remains or is expressed strongly, treatment has to be stopped.

The use of alcoholic beverages during use of drug is strictly forbidden.

During treatment it is necessary to abstain from driving of motor transport and occupations potentially dangerous types of activity demanding the increased concentration of attention and speed of psychomotor reactions.

The indication of features of effect of medicine at the first reception or at its cancellation: There are no data.

Side effects:

From cardiovascular system: dizziness, headache, tachycardia, heat, lowering of arterial pressure; seldom (especially at overdose) - an orthostatic collapse, cyanosis, because of the expressed lowering of arterial pressure drug can strengthen stenocardia symptoms (paradoxical reaction to nitrates). The collapse with a bradyarrhythmia and a loss of consciousness is sometimes observed.

From the alimentary system: dryness of a mucous membrane of an oral cavity, it is rare - nausea, vomiting, abdominal pain.

From the central nervous system: weakness, it is rare - uneasiness, psychotic reactions, block, a disorientation.

Allergic reactions: seldom - skin rash, an itch, exfoliative dermatitis.

Local reactions: a dermahemia, burning under language.

Others: seldom - a sight illegibility, a hypothermia, a methemoglobinemia.

Interaction with other medicines:

Nitroglycerine can strengthen effects of other drugs.

Contraindications:

• collapse;
• shock;
• age up to 18 years (lack of sufficient clinical data);
• simultaneous use of inhibitors of phosphodiesterase of the fifth FDE-5 type (including sildenafit, vardenafit, tadalafit also other FDE-5 inhibitors);
• heavy arterial hypotension (systolic arterial pressure is lower than 90 mm of mercury.);
• cardiogenic shock (if events for maintenance of end diastolic pressure are not held);
• the stenocardia caused by a hypertrophic subaortic stenosis;
• chronic cardial compression;
• pericardium tamponade;
• an acute myocardial infarction and chronic heart failure with the low filling pressure of a left ventricle;
• a heavy stenosis of the aortal and/or mitral valve, primary pulmonary hypertensia (as the hyperemia of not enough ventilated alveolar zones can lead to a hypoxia);
• any state connected with increase in intracranial pressure;
• hypersensitivity to nitrates.

Storage conditions:

In the place protected from light at a temperature not above 15 °C, far from fire. To store in the place, unavailable to children. A period of validity - 2 years.

Issue conditions:

Without recipe

Packaging:

Bottles of 10 ml of solution (200 doses) with a mechanical dispensing pump in packs cardboard.