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 by preventive administration of the drug before physical activity;
– relief of angina attacks;
– acute left ventricular failure (including acute myocardial infarction).

Active ingredient

Composition

Nitroglycerin 4% solution – 250 g

(in terms of nitroglycerin) – 10 g

Ethanol – up to 1000 g

(rectified ethyl alcohol)

How to take, the dosage

Nitrospray-ICN is taken sublingually, in a sitting position, against a background of breath-holding.

Canceling an angina attack: 1-2 doses containing 0.4-0.8 mg of nitroglycerin (if necessary repeated at least 30 seconds later), maximum 3 doses at 5-minute intervals.

Prevention of angina attacks: 1 dose 5-10 min prior to anticipated exertion or stress. The maximum single dose is 1.6 mg (4 doses), the daily dose is 6.4 mg (16 doses).

Interaction

Other antihypertensive drugs, antidepressants, FDE inhibitors (sildenafil), ethanol may increase the hypotensive effect of Nitrospray. At the same time, the effectiveness of Nitrospray may decrease.

Concomitant use with Nitrospray may decrease the anticoagulant effect of heparin.

Special Instructions

Perhaps caution should be exercised with sudden transitions to an upright position from lying or sitting, prolonged standing, physical activity, and hot weather (orthostatic reactions may develop).

Contraindications

– Hypersensitivity to organic nitrates;
– Closed-angle glaucoma;
– Severe arterial hypotension;
– Increased intracranial pressure due to cerebral hemorrhage or trauma;
– concurrent use of phosphodiesterase inhibitors;
– age less than 18 years (insufficient clinical data).

With caution:

acute myocardial infarction with low left ventricular filling pressure (risk of decreased BP and tachycardia, which may worsen ischemia), chronic heart failure with low left ventricular filling pressure, severe anemia, thyrotoxicosis, hypertrophic cardiomyopathy (possible frequency of angina attacks), severe renal failure, hepatic failure (risk of methemoglobinemia).

Side effects

Nervous system and sense organs: headache, dizziness, weakness, blurred vision, motor anxiety.

Cardiovascular system and blood (hematopoiesis, hemostasis): arterial hypotension, reflex tachycardia, increased symptoms of angina pectoris (rare).

Gastrointestinal system disorders: nausea, vomiting, dry mouth.

Skin disorders: facial hyperemia, dermatitis, rash.

Overdose

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

Treatment: transfer patient to supine position with elevated legs, symptomatic and supportive therapy.

Similarities