Nitrospray, sublingual spray 0.4 mg/dose 10 ml

Peripheral vasodilator with predominant effect on the venous vessels. Antianginal drug. It reduces the preload on the heart due to dilatation of the veins, which leads to reduction of the left ventricular end-diastolic volume and reduction of systolic tension of the ventricular walls. It also reduces the post-load on the heart (due to the reduction of PEEP). It reduces myocardial energy expenditure, decreases oxygen demand and improves subendocardial blood flow.

In the mechanism of vasodilation the leading role is played by endothelial relaxation factor (EFR) – by its chemical structure it is nitric oxide, which is formed as a result of nitrate metabolism.

EPR stimulates the formation of cGMP (cyclic-guanosine-3’5′-monophosphate) which relaxes vascular smooth muscle. In addition, nitric oxide effectively inhibits both aggregation and adhesion of platelets to the vascular endothelium.

The action of the drug starts after a few seconds. The duration of action is 30-60 min.

Indications

– Prevention of angina attacks through prophylactic use of the drug before physical activity;
– relief of angina attacks;
– acute left ventricular failure (including acute myocardial infarction).

Pharmacological effect

Peripheral vasodilator with a predominant effect on venous vessels. Antianginal drug. Reduces preload on the heart by dilating the veins, which leads to a decrease in the end-diastolic volume of the left ventricle and a decrease in the systolic tension of the ventricular walls. It also reduces afterload on the heart (due to a decrease in peripheral resistance). Reduces the energy costs of the myocardium, reduces the need for oxygen and improves blood circulation in the subendocardial regions.

In the mechanism of vasodilation, the leading role is played by endothelial relaxation factor (ERF) – in its chemical structure it is nitrogen oxide, which is formed as a result of nitrate metabolism.

EGF stimulates the formation of cGMP (cyclic guanosine-3’5′-monophosphate), which relaxes vascular smooth muscle. In addition, nitric oxide effectively inhibits both aggregation and adhesion of platelets to the vascular endothelium.

The effect of the drug occurs within a few seconds. Duration of action: 30–60 minutes.

Special instructions

Caution must be exercised when abruptly moving to a vertical position from a “lying” or “sitting” position, standing for long periods of time, performing physical activity, or hot weather (the development of orthostatic reactions is possible).

Active ingredient

Nitroglycerine

Composition

Nitroglycerin solution 4% – 250 g

(in terms of nitroglycerin) – 10 g

Ethanol – up to 1000 g

(rectified ethyl alcohol)

Contraindications

– Hypersensitivity to organic nitrates;
– closed-angle form of glaucoma;
– severe arterial hypotension;
– increased intracranial pressure caused by cerebral hemorrhage
or injury;
– simultaneous use of phosphodiesterase inhibitors;
– age under 18 years (lack of sufficient clinical data).

With caution:

acute myocardial infarction with low left ventricular filling pressure (risk of decreased blood pressure and tachycardia, which can increase ischemia), chronic heart failure with low left ventricular filling pressure, severe anemia, thyrotoxicosis, hypertrophic cardiomyopathy (possible increased frequency of angina attacks), severe renal failure, liver failure (risk of developing methemoglobinemia).

Side Effects

From the nervous system and sensory organs: headache, dizziness, weakness, blurred vision, restlessness.

From the cardiovascular system and blood (hematopoiesis, hemostasis): arterial hypotension, reflex tachycardia, increased symptoms of angina (rarely).

From the gastrointestinal tract: nausea, vomiting, dry mouth.

From the skin: facial hyperemia, dermatitis, rash.

Interaction

Other antihypertensive drugs, antidepressants, PDE inhibitors (sildenafil), ethanol may enhance the hypotensive effect of Nitrospray. In this case, the effectiveness of Nitrospray may decrease.

When used simultaneously with Nitrospray, the anticoagulant effect of heparin may be reduced.

Overdose

Symptoms: cyanosis of the lips, nails, palms, dizziness, fainting, a feeling of strong pressure in the head, shortness of breath, unusual fatigue or weakness, weak and rapid heartbeat, elevated body temperature, convulsions.

Treatment: transfer the patient to a lying position with elevated legs, carrying out symptomatic and supportive therapy.

Storage conditions

List B. In a dark place, away from fire, at a temperature not exceeding 30 ° C.
Keep out of the reach of children.

Shelf life

3 years. Do not use after the expiration date indicated on the package.

Manufacturer

Pharmstandard-Leksredstva, Russia