Nitroglycerin-Health tablets 0.5 mg container No. 40

Pharmacological properties

Nitroglycerin (propane-1,2,3-triol trinitrate) is a peripheral vasodilator with a predominant effect on venous vessels. The mechanism of action is associated with the formation of nitric oxide, which activates guanylate cyclase and increases the content of cGMP in smooth muscle cells. This leads to nonspecific relaxation of vascular smooth muscle, mainly venous with blood deposition in the venous system, a decrease in venous return of blood to the heart (preload) and end-diastolic filling of the left ventricle. Systemic arterial dilation, mainly of large vessels, leads to a decrease in OPSS (afterload). Due to these effects, the myocardial oxygen demand decreases, cardiac blood flow improves with its redistribution in favor of ischemic areas. The drug also causes relaxation of the smooth muscles of the bronchi, biliary tract, esophagus, stomach, intestines, and genitourinary system.

When used sublingually, nitroglycerin is quickly and fairly completely absorbed from the oral mucosa and enters the systemic bloodstream directly, bypassing the liver. In smooth muscle cells, nitroglycerin is biotransformed to form NO, di- and mononitrate, and the final metabolite - glycerol. Binding to blood plasma proteins is 60%, the half-life is 4 hours. It is excreted mainly by the kidneys in the form of the above metabolites. When taken sublingually, the effect of nitroglycerin develops after 1-5 minutes and lasts 15-30 minutes.

Indication

Relief of angina attacks.

Application

Adults are prescribed 1 tablet under the tongue until completely dissolved. Repeated administration of 2-3 tablets every 5 minutes for 15 minutes is permissible. The maximum daily dose is 6 tablets. The frequency and duration of use of the drug depend on the frequency and intensity of angina attacks, the effectiveness and tolerability of therapy. The drug is not used to treat children.

Contraindication

Arterial hypotension (systolic blood pressure below 100 mm Hg, diastolic blood pressure below 60 mm Hg), angle-closure glaucoma, intracranial hypertension, cerebral circulation disorders, severe atherosclerosis of cerebral vessels, hypersensitivity to nitro drugs, severe aortic stenosis.

Side effects

Headache, hypotension, reflex tachycardia, facial flushing, dizziness, nausea, methemoglobinemia. Allergic reactions are possible in case of hypersensitivity to the components of the drug.

Interactions

Simultaneous administration of vasodilators, ACE inhibitors, diuretics, tricyclic antidepressants and MAO inhibitors increases the hypotensive effect of nitroglycerin. Administration of β-adrenoceptor blockers and calcium channel blockers enhances the antianginal effect and hypotensive effect of nitroglycerin. Nitroglycerin is incompatible with alcohol, since simultaneous use of alcohol enhances the hypotensive effect and the severity of side effects of nitroglycerin. With simultaneous administration of dihydroergotamine, an increase in its concentration in the blood plasma is possible. Use with sildenafil is contraindicated due to the possibility of developing orthostatic collapse.

Overdose

If the recommended doses are exceeded, headaches of varying severity, dizziness, hypotension, tachycardia, visual disturbances, feelings of heat and chills, sweating, weakness, nausea, vomiting, shortness of breath, convulsions, orthostatic collapse, coma are possible. The patient is transferred to a horizontal position (legs are raised above the head). Treatment is symptomatic (plasma substitutes, sympathomimetics, oxygen).

Storage conditions

In a dry place, protected from light, at a temperature of 15-25 °C.