Nitro
Generic Name
Nitroglycerin 400 mcg Spray
Manufacturer
Various Manufacturers
Country
Global
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nitro 400 mcg spray | ৳ 270.00 | N/A |
Description
Overview of the medicine
Nitroglycerin is a nitrate vasodilator used to treat and prevent acute attacks of angina pectoris (chest pain due to heart disease). It relaxes blood vessels, increasing blood and oxygen supply to the heart while reducing its workload.
Uses & Indications
Dosage
Adults
One metered spray (400 mcg) onto or under the tongue at the first sign of an acute anginal attack. May repeat every 5 minutes for a maximum of 3 sprays within 15 minutes. If pain persists after 3 sprays, seek immediate medical attention.
Elderly
Same as adults.
Renal_impairment
No specific dosage adjustment is generally required, but caution is advised in severe renal impairment.
How to Take
Administer 1 or 2 sprays onto or under the tongue. Do not inhale. Do not spit or rinse mouth for 5-10 minutes after administration. If using for the first time or if it hasn't been used for a while, prime the pump according to manufacturer instructions.
Mechanism of Action
Nitroglycerin is converted to nitric oxide (NO) which activates guanylate cyclase, increasing intracellular cyclic GMP (cGMP). Elevated cGMP leads to smooth muscle relaxation and vasodilation, primarily in veins, reducing venous return (preload) to the heart. This decreases myocardial oxygen demand. It also has some arterial dilating effects.
Pharmacokinetics
Onset
1-3 minutes.
Excretion
Mainly via kidneys as inactive metabolites.
Half life
Very short, 1-4 minutes.
Absorption
Rapidly absorbed from the sublingual mucosa.
Metabolism
Extensively metabolized in the liver (first-pass effect) by glutathione-organic nitrate reductase.
Side Effects
Contraindications
- Hypersensitivity to nitroglycerin or other nitrates.
- Severe anemia.
- Increased intracranial pressure (e.g., due to head trauma or cerebral hemorrhage).
- Concurrent use of phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil) or riociguat.
- Hypertrophic obstructive cardiomyopathy.
- Severe hypotension or hypovolemia.
Drug Interactions
Alcohol
May enhance hypotensive effects and cause orthostatic hypotension.
Riociguat
Potentiation of hypotensive effects. CONCOMITANT USE IS CONTRAINDICATED.
PDE5 Inhibitors (e.g., sildenafil, tadalafil, vardenafil)
Potentiation of hypotensive effects, leading to severe hypotension, cardiovascular collapse, and death. CONCOMITANT USE IS CONTRAINDICATED.
Antihypertensives, Beta-blockers, Calcium channel blockers
May have additive hypotensive effects.
Storage
Store at controlled room temperature (20-25°C), away from heat, direct sunlight, and open flame. Do not refrigerate or freeze. Do not puncture or incinerate the canister.
Overdose
Symptoms include severe hypotension, persistent throbbing headache, flushing, palpitations, visual disturbances, dizziness, syncope, tachycardia, and methemoglobinemia. Treatment is supportive: elevate legs, administer intravenous fluids, and if needed, vasopressors. Methylene blue is used for methemoglobinemia.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is unknown if nitroglycerin is excreted in human milk; caution should be exercised when administered to a nursing woman.
Side Effects
Contraindications
- Hypersensitivity to nitroglycerin or other nitrates.
- Severe anemia.
- Increased intracranial pressure (e.g., due to head trauma or cerebral hemorrhage).
- Concurrent use of phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil) or riociguat.
- Hypertrophic obstructive cardiomyopathy.
- Severe hypotension or hypovolemia.
Drug Interactions
Alcohol
May enhance hypotensive effects and cause orthostatic hypotension.
Riociguat
Potentiation of hypotensive effects. CONCOMITANT USE IS CONTRAINDICATED.
PDE5 Inhibitors (e.g., sildenafil, tadalafil, vardenafil)
Potentiation of hypotensive effects, leading to severe hypotension, cardiovascular collapse, and death. CONCOMITANT USE IS CONTRAINDICATED.
Antihypertensives, Beta-blockers, Calcium channel blockers
May have additive hypotensive effects.
Storage
Store at controlled room temperature (20-25°C), away from heat, direct sunlight, and open flame. Do not refrigerate or freeze. Do not puncture or incinerate the canister.
Overdose
Symptoms include severe hypotension, persistent throbbing headache, flushing, palpitations, visual disturbances, dizziness, syncope, tachycardia, and methemoglobinemia. Treatment is supportive: elevate legs, administer intravenous fluids, and if needed, vasopressors. Methylene blue is used for methemoglobinemia.
Pregnancy & Lactation
Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is unknown if nitroglycerin is excreted in human milk; caution should be exercised when administered to a nursing woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Varies by manufacturer, typically 2-3 years. Once the canister is opened or primed, its effective shelf life may be shorter (e.g., 6 months).
Availability
Available in pharmacies and hospitals
Approval Status
Approved by regulatory authorities (e.g., FDA, DGDA)
Patent Status
Patent expired for generic nitroglycerin
WHO Essential Medicine
YesClinical Trials
Extensive historical clinical trials established the efficacy and safety of nitroglycerin for angina. Specific spray formulations undergo bioavailability and bioequivalence studies to ensure consistent drug delivery.
Lab Monitoring
- Monitor blood pressure and heart rate regularly.
- In cases of suspected methemoglobinemia, measure oxygen saturation and methemoglobin levels.
Doctor Notes
- Educate patients thoroughly on proper spray administration technique and the critical need to call emergency services if angina is not relieved after 3 sprays in 15 minutes.
- Emphasize the absolute contraindication with phosphodiesterase-5 (PDE5) inhibitors due to the risk of severe hypotension.
- Advise patients about common side effects like headache and dizziness, and strategies to manage them (e.g., sitting down).
Patient Guidelines
- Always carry your spray with you.
- Sit down when taking the spray to avoid dizziness or fainting.
- Do not shake the canister.
- Prime the pump as per instructions if not used for a while.
- If chest pain is not relieved after 3 sprays within 15 minutes, seek emergency medical help immediately (call 911 or local emergency number).
Missed Dose Advice
This medication is used on demand for acute relief or proactively before an activity. There is no 'missed dose' for acute use. If used for prophylaxis, take it before the anticipated activity.
Driving Precautions
May cause dizziness or lightheadedness, especially at the start of treatment or after a dose increase. Patients should be advised not to drive or operate machinery if they experience these symptoms.
Lifestyle Advice
- Avoid activities that are known to trigger angina.
- Maintain a healthy lifestyle: manage stress, adopt a balanced diet, and engage in regular, physician-approved exercise.
- Avoid sudden changes in posture (e.g., standing up quickly) to minimize orthostatic hypotension.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.