Nitroglycerin indications. Nitroglycerin: what is it, indications and contraindications, dosage in different types and cases. Some features of the use of the drug


What is Nitroglycerin prescribed for?

Nitroglycerin is a well-known medicine that allows you to effectively resist heart disease. Qualifies in preventing the development of angina pectoris and its harmful consequences. The drug has several advantages. Consider what the drug helps from and what it is prescribed by doctors.

Form of production and composition

  • Tableted. Reception is sublingual. The tablets are white or yellowish in color. An integral component is directly nitroglycerin and other auxiliary elements, in particular lactose, macrogol, crospovidone and povidone;
  • Solution. Contained in ampoules. In addition to the active element, it contains potassium dihydrogen phosphate, sodium chloride, dextrose and water;
  • Sublingual spray. It is a colorless liquid in vials with a dosing pump. Additional component - 95% ethanol;

Also on sale are drops under the tongue, a concentrate for the preparation of a solution administered intravenously.

The action of the medication

The action of the active component is due to an increase in the concentration of guanosine monophosphatases, preventing calcium ions from entering the smooth muscle medium. The vessels also dilate, reducing the venous return to the heart muscle, preventing a large circle of blood flow. It has a beneficial effect on blood vessels and inhibits pain syndromes.

The tablets act up to 1.5 minutes after use. The effect lasts up to half an hour. They are absorbed in the shortest possible period and fully enter the circulatory system.

After using the spray, the maximum concentration in the body is reached in four minutes. Bioavailability is one hundred percent. This is due to the fact that hepatic degradation of the drug is prevented. Communication with blood proteins - 60%. It is excreted by the renal system.

Indications for use

Taking Nitroglycerin is indicated in the following cases:

  • The presence of angina attacks;
  • Biliary tract disorder;
  • Retinal artery pathology;
  • Left ventricular failure.

Contraindications

  • Intolerance to nitrates;
  • Severe heart pathologies - tamponade;
  • Increased intracranial pressure;
  • Rupture of blood vessels in the brain;
  • Closed-angle glaucoma;
  • The release of thyroid hormones into the blood;
  • Previous head injuries
  • Toxic pulmonary edema;
  • Anemia;
  • Minor age;
  • Decreased blood pressure.

People with kidney and liver problems should always consult with a specialist regarding the appropriateness of treatment. Otherwise, an incorrect therapeutic regimen can lead to extremely negative consequences.

Reception during pregnancy and lactation period

In the course of preparing a woman for the process of childbirth, her body bears excessive stress. This is especially true of the heart and blood vessels. This increases the volume of blood, part of which is provided by the fetus. The heart rate increases accordingly.

If you experience pain in the sternum and suspect heart problems, you should immediately contact a doctor. Such, at first glance, nothing dangerous symptoms, in fact, are often the harbingers of severe ailments that require prompt therapy.

The medication is allowed to be taken during the gestation of a child, however, only when the benefits to the mother are really higher than the potential risks to the fetus. As for nursing mothers, this process should be stopped for a while.

Key points of the treatment process

  • Do not allow the solution to get on the body. Pain in the head is possible during absorption;
  • Often the emergence of addiction to the drug;
  • There is a slowdown in the reaction. This indicates the need to abandon potentially hazardous work, control complex mechanisms and vehicles;
  • During the fight against an attack of severe chest pains, it is forbidden to chew the pill. This will cause excessive ingestion of active substances into the circulatory system;
  • During therapy, alcohol is strictly prohibited.

Side effects

As a rule, the agent is usually tolerated without problems, but a number of bad phenomena are not excluded.

Migraine, problems with the vestibular apparatus, a decrease in blood pressure, a weak state, and malfunctions of the visual organs are allowed.

From the gastrointestinal tract, there may be urge to vomit, diarrhea, a feeling of dryness in the mouth.

Sometimes there are skin rashes, characterized as allergies and other equally pleasant phenomena - fever, angina pectoris. In the worst case, the patient can suffer a fatal heart attack.

How to take medication

Instructions for use:

Sublingual pills should be kept until completely dissolved. Swallowing them is prohibited. After the onset of pain, 0.5 to 1 mg is used. With the termination of severe syndromes, resorption can be stopped.

Lack of positive effects suggests an increase in dosage of 0.5 mg. In the absence of the onset of improvement in the condition, you need to urgently seek medical help.

The spray is applied under the tongue. To achieve a sufficient therapeutic effect, 1-2 doses are needed by pressing the dosing pump.

The amount of the injected solution into the body is set by the attending doctor.

Overdose consequences

The patient suffers severe pain in the head, blood pressure goes down, heart rate is destabilized, dizziness, diarrhea, nausea, fever and desire for sleep.

Large dose size - from 20 mg. This amount is capable of causing orthostatic collapse and even coma in the patient, with subsequent death.

Mild forms of overdose are treated by placing the person in a horizontal arrangement. The patient's legs are raised. In a worse situation, general methods of overcoming shock and intoxication are used.

Compatibility with other medications

  • Salicylates. Contribute to a multiple increase in the level of nitroglycerin in the blood;
  • Barbiturates. Accelerates the metabolic processes of nitroglycerin;
  • Heparin. Decreases effectiveness;
  • The effect of the medication taken is enhanced by the concomitant use of antihypertensive and antiadrenergic drugs, as well as sildanefil;
  • Taking acetylcysteine \u200b\u200b(N), ACE inhibitors, increase antianginal activity;
  • Alpha-adrenergic agonists, anticholinergics, histamines, pituitrins, corticosteroids reduce the effect of the pharmaceutical product in question.

How much does Nitroglycerin cost - price in a pharmacy

It is an affordable medicine for almost everyone. The price ranges from 18 to 519 rubles (depending on the issue format). Sale - by prescription of doctors from the relevant institution. The cost information is taken from some of the most famous Russian online pharmacies.

Nitroglycerin analogs

  • Perlinganite

A worthy generic solution. Overcomes all kinds of angina pectoris, the consequences of acute myocardial infarction, hypertensive crisis.

Forbidden in case of acute circulatory problems, obvious hypotension, cardiogenic shock.

It is administered intravenously using an infusion syringe pump. The doctor selects the dose through an individual approach. On average, it ranges from 0.75 to 10 mg. Depends on the severity of the disease.

  • Nitromint

They are used to relieve and prevent the development of symptoms of angina pectoris. Helps with acute left ventricular failure, but only with the use of additional pharmaceuticals.

Not indicated for patients in a state of shock, with a clearly detrimental reaction to the composition and under the age of 18. You need to be especially careful in cases of circulatory problems, including hemorrhagic hemorrhage in the brain, problems with blood pressure, liver and kidney pathologies, and angle-closure glaucoma.

The medicine is sprayed with a spray under the tongue. Enough 1-2 doses - 400 or 800 mcg, respectively. It is necessary to carry out therapy in a sitting position, holding your breath. After applying the drug, the patient closes the oral cavity for several seconds. In some situations, re-engagement is allowed. Insufficient beneficial effect allows repeated use of a similar dose after 10 minutes.

  • Nitrospray

It shows itself well in the fight against heart pain syndrome, does not allow them to develop, it is indicated in acute heart attack.

It is not prescribed for hypersensitive patients, with severe hypotension, cardiomyopathy, stroke with rupture of blood vessels, head injuries, pulmonary edema and angle-closure glaucoma.

It is applied under the tongue. One or two doses are enough to combat the main indications. The maximum is four (1.6 mg). Up to 6.4 mg per day.

  • Nitrosorbide

It is sold in the form of tablets and solution. The latter is intended for intravenous administration. Qualitatively resists angina attacks, and is also discharged in a post-infarction state.

Nitrosorbide is not allowed for people after head injury, low blood pressure, stroke.

The minimum dose is 10 mg, divided into 4-5 doses in 24 hours. To increase the effect, 60–120 mg per day can be used. It stands out from all the sublingual analogs listed in that it is allowed to chew a tablet, which will bring the therapeutic effect even faster. Its period will be determined by a qualified doctor. After achieving a successful clinical picture and proper dynamics, therapy should be discontinued in stages.

  • Nitrogranulong

Prevents and relieves angina-type pain. Competent in patient recovery after suffering myocardial infarction of any form. Produced in the form of tablets and solution. The last medicinal form is used in case of acute manifestations of the listed ailments - it is administered intravenously.

Not intended for the treatment of minors with excessive intraocular pressure, liver and kidney problems. It is necessary to refuse to those carrying a fetus and breastfeeding babies.

The total period of resistance to these ailments depends on the immediate dynamics of the therapeutic period. The doctor establishes the right to establish a clear scheme and rules.

  • Dikor Long

Provides qualified assistance for chest pains and during post-infarction rehabilitation. It dilates blood vessels well, unloads the heart, which allows it to adequately saturate its system with oxygen.

Will not help people with low blood pressure and high intracranial, cerebral hemorrhage, TBI.

Therapeutic rules are established by doctors.

  • Nitrocor

The simplest pill substitute. The main indication is angina pectoris.

Not allowed for people with glaucoma, obvious intracranial pressure, impaired cerebral blood flow and cerebral atherosclerosis.

0.15-0.5 mg tablets are placed under the tongue. Let's say it will repeat after 5 minutes.

Nitroglycerin belongs to the group of azodilating agents. The active ingredient is nitroglycerin.

This is a common name for medicines that contain glycerin trinitrate.

Indications for use

What is Nitroglycerin taken from? Main indications for use:

  • to relieve attacks of angina pectoris;
  • with dyskinesia of the biliary tract;
  • with blockage of the central retinal artery;
  • with myocardial infarction and left ventricular failure.

Method of administration and dosage

Most often, nitroglycerin is used in the form of tablets or capsules, 1% alcohol solution is rarely used.

If using an alcohol solution:

  • apply one or two drops under the tongue or moisten a piece of sugar with 2-3 drops, keep it in the mouth until it is completely dissolved;

The tablets are taken like this:

  • half of the tablet or a whole part is placed under the tongue and kept in the mouth until it dissolves.

The maximum dose of an alcoholic solution of nitroglycerin for an adult is 4 drops, per day - 16 drops. Accordingly, one-time for tablets - 1 or 1/2 and daily - 6 pieces.

In the same way, the capsules of the drug are held under the tongue until they are completely absorbed. You can bite the capsule with your teeth to accelerate the positive effect.

The frequency and duration of the use of nitroglycerin in any form depends on the intensity and frequency of angina attacks, as well as the tolerability and effectiveness of the drug. Usually, after stopping a heart attack, they switch to drugs of longer exposure.

In the practice of ambulance, in case of a heart attack or heart failure in the acute phase, doctors prescribe intravenous nitroglycerin. Before the introduction into the vein of the drug, first give 1-2 tablets under the tongue, repeating the intake every 15 minutes.

Nitroglycerin, which is intended for the prevention of angina pectoris, should be taken orally and washed down with water before meals. In not serious cases, take 0.0029-0.0058 g 3 times a day. And in more serious cases, take 0.0052-0.01 g 3 times a day.

It should be noted that continuous long-term intake of nitroglycerin in any form can provoke the development of tolerance (addiction) to the drug. This can lead to a permanent increase in dose or number of doses.

Since patients have to use nitrates often and for a long time, the effectiveness of therapy should be monitored constantly by adjusting the dosage (possibly for several days), as well as the cancellation of these drugs, replacing them with antianginal drugs of other groups.

Composition. Release form

The active ingredient is nitroglycerin.

The release is made in the form:

  • 1% solution in alcohol in 5 ml vials;
  • tablets of 0.5 mg nitroglycerin, 40 pcs;
  • in the form of capsules of 1% solution in red oil, spherical, 0.5 mg, 20 pieces per package.

Possessing an antispasmodic effect, nitroglycerin has a central inhibitory effect on the sympathetic vascular tone, while inhibiting the component of the formation of pain syndrome.

Side effects

When using nitroglycerin preparations, the following side effects may occur:

  • headache;
  • anxiety and psychotic reactions;
  • lethargy;
  • nausea and vomiting;
  • lowering blood pressure (more often in an upright position of the body);
  • rarely, there may be an allergy in the form of a rash, dermatitis or skin flushing;
  • in case of an overdose - a sharp decrease in blood pressure when changing from horizontal to vertical.

It is best to avoid getting the solution on the skin, as the drug can be absorbed and cause headaches.

Contraindications

Nitroglycerin preparations are contraindicated in the following cases:

  • cerebral hemorrhage;
  • intracranial pressure above normal;
  • hypersensitivity to the constituent elements of the drug;
  • low blood pressure;
  • angle-closure glaucoma (high intraocular pressure).

With open-angle glaucoma, nitroglycerin preparations are not contraindicated.

Any form of nitroglycerin should be taken with extreme caution if:
  • hemorrhagic stroke;
  • intracranial hypertension;
  • acute myocardial infarction with low pressure;
  • severe anemia;
  • thyrotoxicosis;
  • arterial hypotension with low systolic blood pressure;
  • severe renal failure;
  • liver failure;
  • pregnancy and lactation period;
  • under the age of 18 (safety of use has not been established).

When administered intravenously, one should be very careful with cardiac tamponade, traumatic brain injury, constrictive pericarditis, hypovolemia, toxic pulmonary edema and atherosclerosis.

Video

See in the video why the drug Nitroglycerin can be hazardous to health:

Interaction with other drugs

  • with the complex use of nitroglycerin with beta-blockers, vasodilators, sildenafil, ACE inhibitors, antihypertensive drugs, procainamide, MAO inhibitors, tricyclic antidepressants, PDE inhibitors and ethanol, an increase in the hypotensive effect is possible;
  • the combined use of nitroglycerin with dihydroergotamine can increase the concentration of the latter in the blood, as well as raise blood pressure;
  • nitroglycerin and heparin together reduce the effectiveness of the latter, and after the abolition of nitroglycerin, it may be necessary to reduce the dose of heparin.

Storage conditions

Store nitroglycerin preparations in a dark and cool place, away from fire and children's eyes.

Nitroglycerin: instructions for use and reviews

Latin name: Nitroglycerin

ATX code: C01DA02

Active substance: nitroglycerin (nitroglycerin)

Producer: NPF Mikrokhim, LLC Experimental Plant GNTsLS (Ukraine), LLC Ozon, LLC Lumi, LLC Farmamed, Medico-technological holding MTH, Samaramedprom, CJSC Binnopharm, JSC "Biomed" them. I. I. Mechnikova "," Medisorb "(Russia)

Description and photo update: 16.08.2019

Nitroglycerin is a vasodilator drug used to relieve angina attacks.

Release form and composition

Nitroglycerin is available in the following dosage forms:

  • Sublingual tablets: almost white or white, flat-cylindrical, with a rough surface (40 tablets in a polymer test tube, tightly sealed with a polymer stopper, 1 tube in a cardboard box);
  • Dosed sublingual spray: colorless, transparent (in bottles or cylinders of 200 doses (10 ml), 1 bottle or balloon in a cardboard box, complete with a mechanical dosing pump);
  • Concentrate for the preparation of solution for infusion: colorless, transparent (in ampoules of 2, 5 or 10 ml, 5 ampoules in blisters, 1, 2 or 10 packs in a cardboard box).

The composition of 1 tablet sublingual includes:

  • Active substance: nitroglycerin - 0.5 mg (in terms of 100% substance);
  • Auxiliary components: sugar (sucrose) - 7.9 mg, glucose (dextrose) - 9.3 mg, potato starch - 9.3 mg.

The composition of 1 dose of the sublingual spray includes:

  • Active ingredient: nitroglycerin - 0.4 mg;
  • Auxiliary components: 95% ethanol (as a 1% solution).

The composition of 1 ml of concentrate for the preparation of infusion solution includes:

  • Active ingredient: nitroglycerin - 1 mg;
  • Auxiliary components: dextrose, sodium chloride, potassium dihydrogen phosphate, water for injection.

Pharmacological properties

Pharmacodynamics

Nitroglycerin is a peripheral vasodilator that predominantly acts on the venous vessels. Its effect is mainly due to a decrease in myocardial oxygen demand due to a decrease in preload (decrease in blood flow to the right atrium and expansion of peripheral venous vessels) and afterload (decrease in total peripheral vascular resistance).

Nitroglycerin is able to release nitric oxide from its molecule, which is a natural endothelial relaxing factor. The compound increases the concentration of cyclic guanosine monophosphatase inside the cell, which prevents the penetration of calcium ions into smooth muscle cells and provokes their relaxation. Relaxation of the smooth muscles of the vascular wall leads to vasodilation, which reduces the load on the heart and myocardial oxygen demand. Expansion of the coronary vessels helps to improve coronary blood flow and its redistribution in areas characterized by reduced blood circulation, which stimulates the transport of oxygen to the myocardium.

A decrease in venous return causes a decrease in pressure in the pulmonary circulation and filling pressure, an improvement in the blood supply to the subendocardial layers, and a regression of symptoms characteristic of pulmonary edema. Nitroglycerin is characterized by a central inhibitory effect on the sympathetic vascular tone and suppression of the vascular component responsible for the formation of pain syndrome. It also provokes an expansion of the meningeal vessels, which causes a headache after taking it, and relaxes the cells of the smooth muscles of the bronchi, small and large intestines, esophagus, their sphincters, bile ducts, gall bladder, urinary tract.

The use of sublingual forms usually allows you to stop an attack of angina pectoris within 1.5 minutes after oral administration, and the antianginal effect lasts for 30-60 minutes.

Pharmacokinetics

Nitroglycerin is rapidly and almost completely absorbed from the surface of the mucous membranes of the oral cavity. When taken sublingually, it immediately enters the systemic circulation. The bioavailability of the drug is 100%, since the primary hepatic degradation of the substance is excluded. The maximum concentration of nitroglycerin in blood plasma is determined after 4-5 minutes. The metabolism of the substance is carried out rather quickly with the participation of nitrate reductase. In this case, mono- and dinitrates are formed. Only isosorbide-5-mononitrate demonstrates pharmacological activity. The final metabolite is glycerol.

The drug has a very large volume of distribution (1.2 (3.3 l / kg). The degree of binding to blood plasma proteins is 60%. Nitroglycerin is excreted in the urine in the form of metabolites (less than 1% of the dose taken is excreted unchanged), the total clearance is 25-30 L / min (with infusion - up to 78 L / min). After oral sublingual administration drug plasma half-life varies from 2.5 to 4.4 minutes (with infusion - from 1 to 3 minutes). Circulating nitroglycerin strongly binds to erythrocytes and accumulates in the walls of blood vessels.

Indications for use

Indications for the use of Nitroglycerin are:

  • Angina pectoris (relief and short-term prevention of angina attacks before emotional stress or physical exertion);
  • Acute myocardial infarction, including complicated by acute left ventricular failure (infusion solution);
  • Pulmonary edema (infusion solution);
  • Unstable angina (infusion solution).

Contraindications

Absolute:

  • Collapse;
  • Age up to 18 years (the effectiveness and safety of the use of Nitroglycerin for this age group of patients have not been established);
  • Hypersensitivity to drug components.

Depending on the dosage form, additional absolute contraindications to the use of Nitroglycerin are the following diseases / conditions:

  • Glucose-galactose malabsorption (sublingual tablets);
  • Shock (sublingual spray and tablets);
  • Cardiogenic shock, except when taking measures to maintain end-diastolic pressure (sublingual spray);
  • Severe arterial hypotension with systolic blood pressure below 90 mm Hg. Art. (sublingual spray);
  • Constrictive pericarditis (sublingual spray);
  • Angina pectoris associated with hypertrophic obstructive cardiomyopathy (sublingual spray);
  • Acute myocardial infarction and chronic heart failure with low left ventricular filling pressure (sublingual spray);
  • Pericardial tamponade (sublingual spray);
  • Any conditions associated with increased intracranial pressure (sublingual spray);
  • Severe mitral and / or aortic valve stenosis, primary pulmonary hypertension (sublingual spray);
  • Concomitant use with phosphodiesterase-5 inhibitors, including vardenafil, sildenafil, tadalafil (sublingual tablets and spray).

According to the instructions, Nitroglycerin should be used with caution after assessing the benefit / risk ratio:

  • Hemorrhagic stroke;
  • Severe anemia;
  • Thyrotoxicosis;
  • Severe renal impairment;
  • Closed-angle glaucoma;
  • Recent head injuries;
  • Intracranial hypertension;
  • Cardiac tamponade (sublingual tablets and infusion solution);
  • Hepatic impairment (sublingual tablets and infusion solution), severe hepatic impairment (sublingual spray);
  • Arterial hypotension with low systolic pressure - less than 90 mm Hg. Art. (sublingual tablets and infusion solution);
  • Orthostatic hypotension and a tendency to develop orthostatic hypotension (sublingual spray);
  • Alcohol abuse (sublingual spray);
  • Epilepsy (sublingual spray);
  • Migraine (sublingual spray);
  • Constrictive pericarditis (sublingual tablets and infusion solution);
  • Isolated mitral stenosis (sublingual tablets and infusion solution);
  • Hypertrophic cardiomyopathy (sublingual tablets and infusion solution);
  • Toxic pulmonary edema (infusion solution);
  • Idiopathic hypertrophic subaortic stenosis (sublingual tablets), aortic stenosis (infusion solution);
  • Acute myocardial infarction, chronic heart failure with low left ventricular filling pressure (sublingual tablets and infusion solution);
  • Uncontrolled hypovolemia with normal or low pressure in the pulmonary artery in patients with heart failure (infusion solution);
  • Shock, including cardiogenic shock, except in cases with a sufficiently high filling pressure of the left ventricle, incl. provided with drugs with a positive inotropic effect or intra-aortic counterpulsation (infusion solution);
  • Cerebral hemorrhage (infusion solution);
  • Severe cerebral atherosclerosis (infusion solution);
  • Pregnancy and lactation (for all forms of the drug);
  • Elderly age (infusion solution).

Instructions for the use of Nitroglycerin: method and dosage

Sublingual tablets

To prevent complications, Nitroglycerin is recommended to be taken as directed by a doctor.

Nitroglycerin tablets are taken (sublingually) under the tongue, holding in the mouth until completely absorbed, without swallowing.

Nitroglycerin should be taken immediately when the first signs of an angina attack appear or before the expected physical exertion or emotional stress. Single dose - 1 tablet. With stable angina pectoris, the effect can come from a lower dose, in this case the rest of the tablet, which did not have time to dissolve, is recommended to be spit out. In most cases (75% of patients), improvement is noted within the first 3 minutes of using Nitroglycerin.

If the angina attack is not stopped within 5 minutes, you should take another 1 tablet.

If there is no therapeutic effect after taking 2 tablets of Nitroglycerin, you should immediately consult a doctor.

Sublingual spray

Injected into or under the tongue, preferably in a sitting position, while holding the breath. After spraying, the spray is not swallowed immediately, but is held by closing the mouth for a few seconds.

To avoid complications, Nitroglycerin should be used as directed by a physician.

When the first signs of an angina attack appear, 1-2 doses of a spray are administered (depending on the severity). If necessary, it is possible to introduce another 1 dose, but not more than 3 doses (1.2 mg) within 15 minutes.

If, after taking 3 doses for 15 minutes, the condition has not improved, you should consult your doctor.

The maximum single dose is 3 spray doses.

If the indication for the use of Nitroglycerin is the prevention of angina pectoris attacks, the drug is used in 1 dose 5-10 minutes before the expected load or stress.

Do not shake the spray package before use. Hold the bottle upright when spraying.

Infusion solution

The rate of intravenous injection of Nitroglycerin is selected individually, taking into account blood pressure, heart rate, central venous pressure, ECG and other indicators. The solution should be administered through an infusomat or an automatic dispenser, allowing it to be accurately dosed and to control the rhythm of administration.

Administration of Nitroglycerin using a conventional fluid transfer system ensures dosing accuracy by counting the number of drops of fluid being transferred. Before the introduction, the Nitroglycerin solution is preliminarily diluted in 0.9% sodium chloride solution or 5% glucose (dextrose) solution to a concentration of 0.01%. Do not use other solvents.

It is advisable to use glass and polyethylene tubes, since the active substance is absorbed on the walls of the PVC tubes (losses can be 40-80%). Nitroglycerin solution is rapidly destroyed by light, so the transfusion system and vials must be shielded with opaque material. Storage of the solution in an opened ampoule is not allowed.

The initial rate of administration of the solution is 0.5-1 mg per hour, the maximum rate is 8-10 mg per hour.

The recommended concentration and rate of administration of Nitroglycerin are: 1 mg / h (0.0166 mg / min) - 24 mg per day through an automatic dispenser (solution volume 1 mg / ml) or 240 mg per day through an intravenous system (solution volume 0 , 1 mg / ml); the rate of administration is 3-4 drops per minute (1 ml corresponds to 20 drops).

The duration of therapy is determined by clinical indications and can vary from several hours to 2-3 days.

Side effects

  • Central Nervous System: weakness; rarely - psychotic reactions, anxiety, disorientation, lethargy;
  • Digestive system: dryness of the oral mucosa; rarely - vomiting, nausea, abdominal pain;
  • Cardiovascular system: headache, dizziness, fever, tachycardia, low blood pressure; rarely (especially in case of overdose) - cyanosis, orthostatic collapse, increased symptoms of angina pectoris (paradoxical reaction to nitrates); sometimes - collapse with loss of consciousness and bradyarrhythmia;
  • Local reactions: burning under the tongue, flushing of the skin;
  • Allergic reactions: rarely - itching, skin rash, exfoliative dermatitis;
  • Others: rarely - hypothermia, blurred vision, methemoglobinemia.

Overdose

Symptoms of an overdose of Nitroglycerin are: nausea, vomiting, increased drowsiness, severe weakness, asthenia, severe dizziness, headache, seizures, fever, shortness of breath, reflex tachycardia, lowering blood pressure (below 90 mm Hg), accompanied by orthostatic dysregulation ... Taking the drug in high doses (more than 20 mg / kg) can lead to the development of tachypnea, dyspnea, cyanosis, collapse, methemoglobinemia.

If there are signs of an overdose, you should immediately give the patient a horizontal position, lifting his legs, and also seek medical help.

special instructions

The therapeutic doses indicated in the instructions should not be exceeded.

1 tablet of sublingual Nitroglycerin contains 2.65X10 -3 XE (grain units).

During therapy, a significant decrease in blood pressure and the development of dizziness may occur with a sharp transition to an upright position from a lying or sitting position, as well as in hot weather, while exercising or drinking alcohol.

With the preservation or significant severity of blurred vision or dryness of the oral mucosa, treatment should be interrupted.

According to the instructions, Nitroglycerin, like other organic nitrates, can be addictive (in this case, an increase in dosage will be required).

The severity of headache during therapy can be reduced by reducing the dose of the drug and / or concurrent administration of validol.

During the use of Nitroglycerin, the use of alcoholic beverages is strictly prohibited.

The sublingual spray contains alcohol, which is important for lactating and pregnant women, patients with functional disorders of the liver, epilepsy, traumatic brain injury and other diseases of the central nervous system, as well as alcohol abuse.

The infusion solution contains glucose (dextrose), which should be taken into account in patients with diabetes mellitus.

In acute heart failure or acute myocardial infarction, Nitroglycerin should be used only under the condition of careful clinical observation of the patient's condition.

In order to prevent an increase in the frequency of angina attacks, it is recommended to avoid abrupt withdrawal of the drug.

To prevent an undesirable decrease in blood pressure, the rate of administration of the Nitroglycerin infusion solution must be selected individually. A decrease in blood pressure can be observed not only when the rate of administration of the solution is selected, but also later, against the background of initially stabilized blood pressure (monitoring should be carried out at least 3-4 times per hour throughout the entire infusion time).

Patients previously treated with organic nitrates (isosorbide-5-mononitrate, isosorbide dinitrate) may require a higher dose to obtain the desired hemodynamic effect.

During the use of Nitroglycerin, care must be taken when driving vehicles and performing potentially hazardous types of work that require an increased concentration of attention and quick psychomotor reactions.

Drug interactions

With the simultaneous use of Nitroglycerin with some drugs, the following effects may occur:

  • Vasodilators, antihypertensive drugs, angiotensin-converting enzyme inhibitors, phosphodiesterase-5 inhibitors, blockers of "slow" calcium channels, tricyclic antidepressants, ethanol, diuretics, beta-blockers, monoamine oxidase inhibitors, procainamide: an increase in the hypotensive effect;
    • Sublingual tablets: 2 years at temperatures up to 25 ° C;
    • Sublingual spray: 2 years at temperatures up to 15 ° C;
    • Concentrate for solution for infusion: 3 years at a temperature of 5-25 ° C.

"Nitroglycerin" is a medication containing a compound of nitric acid and an ester of glycerin. For 150 years, the medicine has been widely used to quickly eliminate pain in the heart. A wide range of indications for the use of "Nitroglycerin" allows you to use the drug for the treatment of cardiac patients. Its widespread use is due to its vasodilating and antispasmodic properties. But before using "Nitroglycerin", it is recommended to carefully read its instructions for use. It will allow you to find out what helps "Nitroglycerin", in which cases it is contraindicated, what is the mechanism of action of "Nitroglycerin".

"Nitroglycerin" is a drug belonging to the group of nitrates, which has a veno-dilating effect. The mechanism of action of "Nitroglycerin" has the following:

  1. It is caused by nitrogen, which is part of the structure of the drug, which, in combination with oxygen, creates a new chemical substance - nitric oxide.
  2. It is a natural relaxer of the endothelial layer of blood vessels by activating the guanylate cyclase system. In connection with an increase in cGMP, there is an expansion of smooth muscle structures, especially vein fibers. In parallel, the drug relaxes the muscles of the gastrointestinal tract, bronchi, bile ducts and urinary tract. Intravenous administration allows peripheral veins to expand, which reduces cardiac overload.

As a result of vasodilatation in the right atrium, blood flow decreases, the pressure in the pulmonary circulation goes away, as a result of which the manifestations of symptoms in pulmonary edema become less acute. In the area with reduced blood supply, blood flow is redistributed, the pressure in the chambers is returned to normal, tension and stress on the heart are relieved, this reduces the oxygen demand of the myocardium. The drug inhibits the negative effect on the sympathetic fibers of the vessels, which helps to relieve pain. Due to the use of the drug, the cerebral vessels also expand, therefore sometimes after taking it, a headache occurs.

Due to the property to remove the tone of the walls of the coronary vessels and expand their lumen, the drug is prescribed for people with various heart diseases to stop manifestations of angina pectoris of any type, relieve pain, and improve the condition after a heart attack.

Existing forms of release

The rate of absorption and activity of action is due to the form of the drug and the variant of its use. "Nitroglycerin" release form:

  1. With sublingual administration (under the tongue) of tablet forms or capsules, the drug is completely absorbed. Its effect is felt in a minute - one and a half after dissolution in the oral cavity, the duration of exposure is about half an hour. Bioavailability is 100%. After 5 minutes, the active substance, having reached its maximum concentration in the blood plasma, binds to proteins by 60%.
  2. When ingested tablets with a shell for prolonged action, the substance, passing through the digestive system, is absorbed into the bloodstream in the small intestine. Begins to act after half an hour after swallowing, bioavailability is no more than 10%.
  3. "Nitroglycerin" spray, after spraying on the mucous membrane under the tongue, is quickly and completely absorbed, the drug appears in the bloodstream almost immediately, in the plasma it accumulates to the maximum after 4 minutes. When excreted by the kidneys, less than 1% of the taken volume is excreted from the body.
  4. The film for sticking to the gums stops the attack in a minute and a half.
  5. The concentrated liquid for injection is injected directly into a vein.
  6. The ointment is used externally (also for the treatment of hemorrhoids). The effect is observed after a quarter of an hour, maximum after an hour. The drug lasts up to 5 hours.
    The transdermal system is represented by a multilayer patch. Application of "Nitroglycerin" through skin provides a constant drug release. The gradual flow of the active ingredient into the blood vessels of the dermis ensures its presence in the vascular bed in a stable concentration for the entire period while the patch is on the skin. The dose depends on the size of the area that the patch covers. The result after gluing appears in half an hour (the maximum period reaches 3 hours), the effect of "Nitroglycerin" lasts up to 10 hours.

The agent is metabolized in the liver, excreted from the body by the kidneys. When taking “Nitroglycerin”, it is important to remember that its long-term use, especially of prolonged forms, forms tolerance (resistance) to the component. The result is a decrease in productivity. Therefore, while taking the medication, the doctor recommends pauses in its use for 8 to 12 hours.

Indications

The indications for the use of "Nitroglycerin" include:

  • prevention and treatment of an attack of angina pectoris;
  • myocardial infarction and post-infarction period;
  • blockage of a retinal artery;
  • dyskinesia of the bile ducts;
  • acute panventricular failure, accompanied by pulmonary edema.

The drug is used in surgery to prevent blood loss.

Rules of admission

"Nitroglycerin" instruction contains the following data on the rules of admission:

Tablet forms

How to take a capsule or tablet sublingually? At the moment when heart pain appears, the drug is placed under the tongue in a dosage of 0.5 to 1 mg. If the pain syndrome does not go away, it is allowed to use another 0.5 mg after 5 minutes. A repeated dose can be taken in half an hour. When a positive result occurs, if the tablet has not had time to dissolve, it must be removed from the mouth. How many tablets are allowed in one dose? For one attack, no more than 3 pieces are used. If the effect did not come, most likely a heart attack developed. Urgent medical attention required.

When pain in the heart occurs frequently, the doctor prescribes a prolonged-release medicine for preventive purposes. Retard is available in 2.6 mg tablets. Reception of "Nitroglycerin" is carried out at least 3 times a day. In severe cases, the dosage is doubled. But if an attack develops, you can additionally take one pill under the tongue. Long-acting "nitroglycerin" should be swallowed, therefore its effect occurs later, since part of the active component is inactivated in the liver. Medicines are indicated for the prevention of an attack before emotional or physical stress.

"Nitroglycerin" aerosol

Available in cans, sublingual use. A convenient form allows you to quickly enter the required dose to eliminate an attack of angina pectoris and with the development of pulmonary edema. Nitrospray is introduced according to the instructions for use: while sitting, shaking the can, spray the drug into the mouth with one or two presses of the dispenser. In this case, breathing must be delayed, you do not need to swallow immediately. During severe heart pains, nitrospray is also used. The instruction allows you to use up to 3 clicks with an interval of 5 minutes. For pulmonary edema, the maximum volume is 4 doses. The medicine can be used in the amount of one dose for prophylaxis before stress or physical activity in 5 minutes.

Film

The composition of "Nitroglycerin" from a bio-soluble polymer ("Trinitrolong") has the following: 1 - 2 mg of the active ingredient. The film is glued to the mucous membrane of the upper gums. After the appearance of painful sensations, it is pressed with fingers for a few seconds. To increase the suction rate, you can run your tongue over it a couple of times, trying not to budge. When the pain has passed, and the film has not dissolved, it is removed. If the effect does not come within 5 minutes, it is allowed to use the medicine again. After two unsuccessful use, immediate medical attention is required.

Drops

The drops are a 1% solution of nitroglycerin in alcohol. They are used sublingually to relieve pain. One or two drops are applied to a sugar cube, put in the mouth and dissolve until dissolved.

Ointment

How to apply nitroglycerin ointment? Initially, for cutaneous use, the permissible volume of the product is 2.5 cm of the column. If the dosage is insufficient, it is gradually doubled, it is permissible to apply up to 10 cm per day. The ointment is squeezed onto a dosage paper, attached to the skin without hair.

Intravenously

Intravenous "Nitroglycerin" is administered, individually adjusting the rate of solution entering the blood. For this, a special dispenser or dropper is used. In the latter case, drops are counted. The initial injection rate is 5 μg / min. In the future, after 3 - 5 minutes, it is increased. The figure will depend on the reaction of the body - indicators of pressure and heart rate. The duration of treatment is usually up to 3 days. If necessary, the administration is resumed.


Interaction

At the reception with a cardiologist, it is important to tell about all the medications taken so that there are no undesirable reactions:

  1. The use of "Nitroglycerin" in parallel with vasodilators, some types of antidepressants, anti-arrhythmia pills, diuretics or drugs for pressure and beta-blockers enhances the hypotensive effect.
  2. When taken simultaneously with salicylates, the concentration of the drug increases.
  3. When administered intravenously, the agent reduces the effect of "Heparin".

"Nitroglycerin" cannot be used together with alcohol, as the risk of hypotension increases. Moreover, any such heart disease presupposes the rejection of alcohol-containing beverages, since the product negatively affects the state and functioning of the organ. The air temperature should also be taken into account: in the warm season, in hot weather, a sharp drop in pressure is also possible.

Contraindications

Has "Nitroglycerin" and contraindications. The drug is not prescribed in the following cases:

  • with intolerance to nitrates;
  • with hypotension;
  • with galactosemia;
  • with tamponade of the pericardium;
  • with adhesive pericarditis;
  • while taking phosphodiesterase inhibitors.

It is used with extreme caution when:

  • increased ocular and intracranial pressure;
  • tendency to hypotension;
  • congestion in the right ventricle of the heart;
  • low hemoglobin;
  • hyperthyroidism;
  • severe kidney and liver diseases;
  • heart valve defects.

Do not prescribe "Nitroglycerin" during pregnancy and lactation, as well as young people under 18 years of age.


Side effects

TO side effects after using "Nitroglycerin" include:

  1. The nervous system is worried about dizziness, coming headaches, a feeling of fullness inside the head, weakness, the development of paradoxical effects.
  2. The heart and blood vessels can respond with hot flashes to the skin surface, hypotension, palpitations.
  3. The digestive organs react with nausea, dry mouth, sometimes vomiting, diarrhea.
  4. Allergy is expressed by itching; when using cutaneous forms, contact dermatitis is not excluded.

With glaucoma, reduced vision and exacerbation of the disease are possible.

Overdose "Nitroglycerin"

You can get an excess dose of the drug by taking it in any form, and the onset of the collapse is noted. The condition is characterized by a sharp drop in pressure when standing up. Also, an overdose of "Nitroglycerin" is manifested:

  • increasing weakness;
  • lowering blood pressure indicators;
  • an increase in blood methemoglobin;
  • shortness of breath and burning sensation in the throat;
  • puffiness on the skin;
  • the development of cyanosis (the appearance of blue areas on the skin);
  • hypothermia;
  • ischemia, the development of a heart attack with a sudden death is not excluded.

The drug belongs to toxic substances, since absorption through the mucous surface occurs quickly. The volume of the drug that can cause poisoning with "Nitroglycerin" ranges from 25 - 75 mg.

Lethal dose of "Nitroglycerin"

The drug "Nitroglycerin" also has a lethal dose, because this chemical actively affects the body. These indicators are individual for each person. Severe poisoning develops if you drink 100 - 150 mg / kg, with a possible death. When ingested 210 mg / kg, death occurs after 2 minutes. Situations were noted when the death of a patient occurred when using the recommended dose, but the interval between doses was not observed.

Any form of "Nitroglycerin" requires a doctor's prescription in a strictly specified dosage. They drink the drug on their own if the doctor has recommended its use during attacks or as a prophylaxis. If the action of "Nitroglycerin" does not appear, call an ambulance.

Doctor D. Merrill, practicing in England in the middle of the 19th century, observed workers breathing in the fumes of nitroglycerin. As a result, he found that the effect of nitroglycerin on the heart in minimal doses is positive for vascular spasms. Currently, the drug is prescribed for high blood pressure and excessive stress on the heart muscle.

This life-saving Nitroglycerin

Reception of Nitroglycerin is justified in emergency conditions, it is indicated for patients in the departments of gastroenterology, surgery and cardiology. Most often, elderly patients have it in their purse to use it for heart pain, sudden onset of angina pectoris. Nitroglycerin helps to restore the work of the heart muscle in case of its dysfunction, as well as in case of hypertension.

Fact on the topic! The active ingredient of Nitroglycerin is glycerin trinitrate (pure organic matter), which reduces vascular tone, as a result, the muscle tissue of the vessels relaxes, they expand, the blood flow improves.

As a result, the volume of blood decreases, the pressure of the fluid flowing to the right atrium decreases, the load on the organ becomes less, and, accordingly, its work improves. Due to the optimal blood flow, metabolism is normalized, oxygen starvation is eliminated, tissues that were deficient in O2 work better, and the deterioration of myocardial trophism is neutralized.

You can take Nitroglycerin from the heart, with spasm of smooth muscle fibers of the bronchi, narrowing of the gallbladder ducts and deterioration of bile output, with poor bowel function. The Nitroglycerin tablet will help with high blood pressure (), by acting on the smooth muscles of the vessels, the spasm is relieved, the vascular lumen becomes larger, the blood flow flows freely, the pressure decreases.

Important! At the very first use, orthostatic hypotension may occur. Nitroglycerin for hypotensive patients is indicated for use with caution, you need to start with minimal doses, constantly exercising control over blood pressure.

The maximum allowable number of tablets per day is 6 pcs., Drops - no more than 16.

For reference! Orthostatic hypotension can develop as a result of taking Nitroglycerin. There is a sharp decrease in pressure - the upper one by 20 units or more, the lower one by 10 units. The situation develops when the patient moves from a horizontal to a vertical position, the blood pressure drops during the first 3-4 minutes after standing up. Pathology is not an independent disease, it is explained by a change in the regulation of blood pressure.

Taking Nitroglycerin is justified:

  1. With a very high blood pressure and an attack of angina pectoris.
  2. As a preventive measure to prevent angina pectoris paroxysm in hypertensive patients, before psychophysical stress. It is justified to use Nitroglycerin for people with consistently high blood pressure, 2-3 minutes before walking in the winter season, when climbing a mountain, stairs, etc.
  3. With biliary colic, an attack of acute pancreatitis, spasm in the gastrointestinal tract, spastic intestinal dyskinesia.

In the presence of hypertension, taking Nitroglycerin cannot be disorderly, it is important to follow certain rules that will be voiced by the attending physician. Only then will the therapy be safe and effective.

Typical Assignment Rules: Schema Explanations


Nitroglycerin dissolves quickly active substance (DV) enters the bloodstream and the therapeutic effect occurs within the first 2 minutes after administration, the duration of the drug's effect is up to 20-30 minutes.

With psycho-emotional or physical exertion, when palpitations appear and heart pain lasts more than 2 minutes, it is recommended to take 1/2 or a whole sublingual (under the tongue) tablet of Nitroglycerin. In the same doses, the drug is used in capsules.

The undoubted plus of Nitroglycerin is its rapid dissolution; before taking it, it is recommended to take a sitting or lying position to prevent dizziness and fainting.

Important points of application:

  • It is better to start the first intake of Nitroglycerin with half the dose (1/2 table) in order to exclude a negative reaction to the drug. This dose is recommended for people who are prone to fainting.
  • Nitroglycerin is indicated for use in chest pain and heart pain at rest. If there is no effect for more than 2 minutes, you can take the dose again 5 minutes after the first dose, but no more than 3 times in a row, an overdose is possible.
  • A prolonged attack cannot be ignored and tolerated, since there is a possibility of myocardial infarction, you must immediately call an ambulance.
  • In the form of drops, Nitroglycerin is indicated for hypertensive patients. As a therapy, the agent is dripped onto a piece of sugar (2–4 drops) and placed under the tongue until it is completely dissolved.

In the absence of a reception system, ignoring the doctor's recommendations, there is a risk of a sharp decrease in pressure, collapse, the patient has pallor of the mucous membranes, weakness, nausea.

General list of indications for admission: when you can and cannot

With prolonged use of Nitroglycerin for heart pathologies, the drug loses its effectiveness, it is necessary to remember this and replace the agent in a timely manner - which one, the cardiologist will say.

Indications for the heart:

  1. Angina pectoris and its prevention.
  2. Necrotic foci in the myocardium (acute ischemic necrosis).
  3. Heart failure.
  4. With hypertensive crisis and accompanying pain in the heart.

It is also indicated for pulmonary edema (4 doses in the form of an aerosol, IV drip 1% solution), acute pancreatitis, with a decrease in the motility of the biliary tract. During operations in the Department of Neurosurgery, Nitroglycerin is used as a means of artificially lowering pressure.

Important nuances


Red Nitroglycerin capsules include an oil solution, so the effect of the main substance of the drug stretches over time and blood pressure decreases gradually. This is justified if the patient has a slight increase in blood pressure or there is a risk of excessive "collapse" of indicators.

With angina pectoris, there is no need to use this form of the drug, it is enough to use traditional sublingual tablets, drops or aerosols.

With glaucoma or after a stroke, Nitroglycerin cannot be taken on its own, only after an in-person consultation with a doctor and in doses strictly prescribed by him.

To prevent addiction, you need a break between courses of 30 days.

For hypotonic patients, Nitroglycerin is indicated with caution, a strong decrease in blood pressure will put stress on the heart, provoke a headache, dizziness and nausea.

Sometimes there is a disorder of visual functions when taking Nitroglycerin, this can be noticed when looking at something dark, located in a white background. The patient notes the appearance of bluish circles around the edges, and yellowish circles in the center.

Nitroglycerin can provoke an increase in intraocular pressure, if this fact is recorded, then the medication is stopped.

Side effects, restrictions and how to store

Nitroglycerin should not be considered a panacea for heart pain or hypertension, despite the widespread approval of the drug by doctors and patients. If the dosage is violated, it is easy to "get" the following negative effects:

  1. Feeling of dry mouth.
  2. Nausea.
  3. General weakness, desire to sleep.
  4. Weakness is accompanied by dizziness.
  5. There may be stomach pains.
  6. The pallor of the mucous membranes and skin is visually visible.

The individual intolerance to the drug strictly limits the intake of Nitroglycerin, in the elderly, the drug can provoke constipation, then its reception is combined with gentle laxatives, better of plant origin.

  • Increased ICP.
  • Hematomas in the head region, cerebral hemorrhage.
  • Glaucoma and heart attack.
  • Pregnancy and HB.

In childhood, the drug is not used.

Store Nitroglycerin in the refrigerator in a "native" container. In the opened state, the drug quickly loses its properties, after 2 months its effectiveness is 30% lower. With a rare single dose, a medicine in the form of a spray is more suitable.

The price of Nitroglycerin is low, which makes it affordable for patients with different income levels. Produced in ampoules (they are more expensive, up to 500 rubles), tablets, capsules, drops, spray.

On the basis of the chemical, the production of prolonged (long-acting) products has been established, the most famous are: Sustac forte, Nitrong, Erinit, Nitrosorbit. They are taken on the eve of going out into the cold, with the upcoming psychophysical stress.

These funds are able to prevent the appearance of angina pectoris, which, of course, pleases patients who are away from home for 3-6 hours.

The biggest disadvantage of prolonged-release agents is the inability to quickly stop an attack (at least after 20 minutes), therefore, Nitroglycerin in its pure form remains indispensable.

As an exception, Nitrosorbitol, a sublingual agent that acts 5 minutes after ingestion, can be noted. But emergency care for an acute attack of angina pectoris must be stopped with Nitroglycerin.

Long-acting nitroglycerin preparations can be used as therapeutic agents in the presence of heart failure. Their effect is based on a decrease in the flow of venous blood to the heart, thereby eliminating stagnation in the pulmonary circulation. But such drugs cannot give the heart muscle the necessary strength for good functioning, although they show an adequate response in cardiac asthma and the weakening of its attacks.

Related facts! Currently, work is underway to create a more modern drug that relieves pain well in angina pectoris. But until now, no substance has been found that could adequately replace Nitroglycerin.