Instructions for Nitromint (Nitroglycerin) spray
Pharmacological properties
nitroglycerin has a dilatatory effect on the smooth muscles of blood vessels. Reduces myocardial oxygen demand by reducing pre- and post-load on the heart, which is associated with the expansion of venous and arterial vessels. Improves coronary blood flow in ischemic myocardial zones, increases cardiac output and tolerability of exercise. When applying Nitromint aerosol to the oral mucosa, the active substance is quickly absorbed and the action of the drug develops for 1-1.5 minutes.
During the application of Nitromint in the form of an aerosol, active diffusion and rapid absorption of nitroglycerin from the oral cavity into the blood are ensured. Bioavailability averages 39%. The preparation penetrates the blood for 1-1.5 minutes, where the maximum concentration is reached 4 minutes after administration and lasts up to 30 minutes. Half-life is 2.5-4.4 minutes. Binding to blood plasma proteins is 60%. Basically, Nitromint is excreted from the body with urine in the form of metabolites, less than 1% of the administered dose - in unchanged form.
Indications:
Nitromint aerosol is used to treat and prevent attacks of angina pectoris (congestion pain). In case of acute left-ventricular insufficiency, the preparation is used as part of complex therapy.
Application:
Dose of preparation is selected individually taking into account patient's sensitivity to nitroglycerin and disease severity. When pressing the dispensing valve once, 1 dose corresponding to 0.4 mg of nitroglycerin is supplied from the cylinder.
To stop an attack of angina pectoris, it is necessary to sublingual introduce 1-2 doses - do 1-2 injections of the drug under the tongue, pressing the dosing valve. If necessary, it is possible to increase the dose, but not to use more than 3 doses for 15 minutes.
To prevent the development of an angina attack during exercise, 1 dose is used 5-10 minutes before the load.
Acute left-ventricular insufficiency, accompanied by pulmonary edema or without it, as well as acute myocardial infarction: it is recommended to use 1-3 doses in the conditions of recording hemodynamics (systolic BP not lower than 100 mm Hg). In the absence of a treatment effect, the same dose can be repeated after 10 minutes.
The balloon metering pump must be filled with air before first use. To do this, remove the warning cap and press the valve several times before the aerosol appears.
Method of use:
If possible, take a sitting position. Remove the warning cap. Hold the bottle vertically, place the index finger on the valve and press the valve several times until aerosol appears. Direct the nebulizer into the oral cavity, preferably under the tongue, hold your breath.
Press the valve hard. If necessary, introduce another 1 dose. In case of repeated administration of doses between sprays, hold a pause of 30 s.
Contraindications:
Nitromint aerosol is not recommended for:
Hypersensitivity to organic nitrates
Acute vascular insufficiency (shock, collapse);
hypotension (systolic blood pressure ≤90 mmHg);
Cardiogenic shock;
angina caused by hypertrophic cardiomyopathy;
Pericardial heart tamponade;
aortic and mitral stenosis;
Primary pulmonary hypertension;
increased intracranial pressure due to intracerebral hemorrhage or injury.
Side effects:
- Headache
- palpitations
- decreased blood pressure
- dizziness, weakness.
- In isolated cases there is a pulsation in the head, hot flashes to the face, headache, feeling of heat, nausea, vomiting, sweating, skin allergic reactions. Sometimes there may be a collapse with bradyarrhythmia.
Special instructions:
In the case of migraine and closed-angle glaucoma, use Nitromint aerosol with special care, under medical supervision. During pregnancy, it is necessary to carefully assess the benefit/risk ratio before prescribing the drug.
Nitromint aerosol enhances urinary release of catecholamines and vanillylmondal acid, and also contains ethanol. Its use can be dangerous in liver disease, alcoholism, epilepsy, brain injury, CNS diseases, in childhood.
Nitromint aerosol is prohibited during smoking or near an open flame. When the aerosol is used, a temporary burning sensation may appear in the mouth. The use of aerosol can cause dizziness, this should be borne in mind when driving vehicles and working with mechanisms, especially at the beginning of treatment. It is strictly forbidden to consume alcoholic beverages during treatment with Nitromint.
Interactions:
Nitromint should be used with caution in combination with:
antihypertensive drugs: β-adrenoceptor blockers, calcium channel blockers - possible increase of antihypertensive effect;
tranquilizers (chlordiazepoxide, trimetocin, thophysopam) - possible increase of antihypertensive effect;
Imipramine-type tricyclic antidepressants - possible increase in antihypertensive effect;
diuretics - risk of hypotension;
heparin - reduction of heparin effect;
dihydroergotamine (effect of dihydroergotamine is increased).
It is not recommended to prescribe Nitromint combined with sildenafil - the risk of developing hypotension.
Patients who previously used nitrates (dinitrate isosorbide, mononitrate isosorbide), Nitromint aerosol is prescribed in high doses (reduction of the effect of nitroglycerin due to binding to nitrates).
Overdose:
Symptoms
Headache, severe arterial hypotension, tachycardia, dizziness, hot flashes, vomiting, diarrhea, methemoglobinemia. In case of excessive overdose, cyanosis, dyspnea and tachypnea and changes in blood indicators (methemoglobinemia) are possible.
Treatment:
In case of collapse, infusion of 0.9% of sodium chloride, norepinephrine and/or dopamine is shown.
In methemoglobinemia:
in/in administration of methylene blue (maximum 50 ml of 1% p-p); ascorbic acid in/in - 1 g as a sodium ascorbic acid salt or as tablets - 1 g inside;
toluidine blue at an initial dose of 2-4 mg/kg body weight v/v, then - 2 mg/kg repeatedly;
oxygen therapy, hemodialysis, blood transfusion, hemotransfusion.
Storage conditions:
At a temperature of 15-25 ° C in places protected from the action of light, sources emitted by heat, away from the fire.
