Nitromint
Generic Name
Glyceryl Trinitrate (Nitroglycerin)
Manufacturer
Egis Pharmaceuticals
Country
Hungary
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| nitromint 400 mcg spray | ৳ 250.00 | N/A |
Description
Overview of the medicine
Nitromint contains glyceryl trinitrate (nitroglycerin), which is used to relieve and prevent angina attacks. It works by relaxing blood vessels, improving blood flow to the heart and reducing its workload.
Uses & Indications
Dosage
Adults
One 0.5 mg sublingual tablet (or 1-2 sprays) at the onset of angina attack. May repeat every 5 minutes for a maximum of 3 doses in 15 minutes. Seek immediate medical help if pain persists after the third dose.
Elderly
Similar to adult dosage, but caution is advised due to increased sensitivity to hypotensive effects.
Renal_impairment
No specific dose adjustment required, but caution is advised due to potential accumulation of metabolites in severe impairment.
How to Take
Place tablet under the tongue and allow it to dissolve completely. Do not chew or swallow. For spray, spray under the tongue, do not inhale.
Mechanism of Action
Nitroglycerin is converted to nitric oxide in the body, which activates guanylyl cyclase, increasing cyclic GMP (cGMP). This leads to relaxation of vascular smooth muscle, primarily venous dilation, reducing preload and myocardial oxygen demand.
Pharmacokinetics
Onset
1-3 minutes (sublingual)
Excretion
Excreted as inactive metabolites, mainly via urine.
Half life
1-4 minutes
Absorption
Rapidly absorbed from sublingual mucosa. High first-pass metabolism when administered orally, but sublingual route bypasses this.
Metabolism
Primarily hepatic metabolism by glutathione-dependent organic nitrate reductase, forming inactive metabolites.
Side Effects
Contraindications
- Hypersensitivity to glyceryl trinitrate or other nitrates
- Severe anemia
- Increased intracranial pressure (e.g., cerebral hemorrhage, head trauma)
- Severe hypotension or shock
- Concurrent use of phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil)
- Constrictive pericarditis or cardiac tamponade
Drug Interactions
Alcohol
May enhance hypotensive effects and cause dizziness or syncope.
Phenothiazines
May enhance hypotensive effects.
Tricyclic antidepressants
May enhance hypotensive effects.
PDE5 inhibitors (sildenafil, tadalafil, vardenafil)
Absolute contraindication: Severe, life-threatening hypotension and cardiovascular collapse.
Antihypertensives (beta-blockers, calcium channel blockers, diuretics)
Additive hypotensive effects. Close monitoring required.
Storage
Store below 25°C, protected from light and moisture. Keep in the original packaging, tightly closed, and away from children.
Overdose
Symptoms include severe hypotension, tachycardia, flushing, headache, nausea, vomiting, syncope, and potentially methemoglobinemia. Management is supportive: elevate legs, administer intravenous fluids, vasopressors if needed. Methylene blue may be used for methemoglobinemia.
Pregnancy & Lactation
Pregnancy Category C. Use only if clearly needed and the potential benefit outweighs the potential risk to the fetus. It is unknown whether nitroglycerin is excreted in human breast milk; use with caution in breastfeeding mothers.
Side Effects
Contraindications
- Hypersensitivity to glyceryl trinitrate or other nitrates
- Severe anemia
- Increased intracranial pressure (e.g., cerebral hemorrhage, head trauma)
- Severe hypotension or shock
- Concurrent use of phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil)
- Constrictive pericarditis or cardiac tamponade
Drug Interactions
Alcohol
May enhance hypotensive effects and cause dizziness or syncope.
Phenothiazines
May enhance hypotensive effects.
Tricyclic antidepressants
May enhance hypotensive effects.
PDE5 inhibitors (sildenafil, tadalafil, vardenafil)
Absolute contraindication: Severe, life-threatening hypotension and cardiovascular collapse.
Antihypertensives (beta-blockers, calcium channel blockers, diuretics)
Additive hypotensive effects. Close monitoring required.
Storage
Store below 25°C, protected from light and moisture. Keep in the original packaging, tightly closed, and away from children.
Overdose
Symptoms include severe hypotension, tachycardia, flushing, headache, nausea, vomiting, syncope, and potentially methemoglobinemia. Management is supportive: elevate legs, administer intravenous fluids, vasopressors if needed. Methylene blue may be used for methemoglobinemia.
Pregnancy & Lactation
Pregnancy Category C. Use only if clearly needed and the potential benefit outweighs the potential risk to the fetus. It is unknown whether nitroglycerin is excreted in human breast milk; use with caution in breastfeeding mothers.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years, check specific packaging for exact expiry date.
Availability
Pharmacies, Hospitals
Approval Status
Approved
Patent Status
Generic available
WHO Essential Medicine
YesClinical Trials
Glyceryl trinitrate has been extensively studied for its efficacy in the acute and prophylactic management of angina pectoris, with numerous clinical trials demonstrating its rapid onset of action and effectiveness.
Lab Monitoring
- Blood pressure monitoring is essential, especially at the start of treatment. Rarely, methemoglobin levels if high doses or signs of methemoglobinemia are present.
Doctor Notes
- Counsel patients on the correct sublingual administration technique and the importance of sitting down before taking the tablet.
- Emphasize the absolute contraindication with phosphodiesterase-5 inhibitors (e.g., sildenafil) and advise patients to report any recent use of such medications.
- Advise patients to seek immediate medical attention if angina pain persists after 3 doses within 15 minutes.
- Monitor for signs of hypotension, especially at the initiation of therapy.
Patient Guidelines
- Keep the medicine readily accessible at all times.
- Sit down before taking the tablet to avoid dizziness or fainting.
- If chest pain persists after 3 doses within 15 minutes, call emergency services immediately.
- Do not chew, crush, or swallow the tablet.
Missed Dose Advice
Nitromint is typically used on demand for acute angina. If used prophylactically and a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not take a double dose to make up for a missed one.
Driving Precautions
May cause dizziness, lightheadedness, or blurred vision, especially at the start of treatment or with alcohol consumption. Avoid driving or operating machinery until you know how Nitromint affects you.
Lifestyle Advice
- Avoid sudden standing or rapid changes in posture to prevent orthostatic hypotension.
- Limit or avoid alcohol intake, as it can worsen hypotensive effects.
- Follow a heart-healthy diet and exercise regimen as advised by your doctor.
- Avoid hot baths or showers, as these can exacerbate hypotension.
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