Nitromint
Generic Name
Glyceryl Trinitrate (Nitroglycerin)
Manufacturer
Gedeon Richter Plc.
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 400 mcg Spray contains Glyceryl Trinitrate (Nitroglycerin), a fast-acting nitrate used to relieve and prevent angina attacks. It works by relaxing blood vessels, improving blood flow to the heart.
Uses & Indications
Dosage
Adults
One or two sprays (400-800 mcg) under the tongue at the onset of an angina attack. Repeat every 5 minutes if pain persists, up to a maximum of 3 sprays within 15 minutes. If pain continues, seek immediate medical attention.
Elderly
No specific dosage adjustment required, but use with caution due to increased sensitivity.
Renal_impairment
No specific dosage adjustment recommended, but use with caution.
How to Take
Administer by spraying directly onto or under the tongue. Do not inhale the spray. For best absorption, do not rinse mouth, eat, drink, or smoke for a few minutes after administration.
Mechanism of Action
Glyceryl Trinitrate is converted to nitric oxide (NO) in vascular smooth muscle cells. NO activates guanylyl cyclase, increasing cyclic GMP (cGMP) levels, which leads to dephosphorylation of myosin light chains and relaxation of smooth muscle. This results in vasodilation, primarily of veins, reducing preload and myocardial oxygen demand, and also dilates coronary arteries, improving oxygen supply.
Pharmacokinetics
Onset
1-3 minutes
Excretion
Excreted primarily via the kidneys as metabolites.
Half life
Approximately 1-4 minutes (for active GTN)
Absorption
Rapidly absorbed from the sublingual mucosa, avoiding first-pass metabolism.
Metabolism
Extensively metabolized in the liver by glutathione-organic nitrate reductase (primarily to inactive metabolites).
Side Effects
Contraindications
- Hypersensitivity to glyceryl trinitrate or other nitrates
- Severe anemia
- Increased intracranial pressure
- Circulatory collapse and severe hypotension
- Concomitant use with phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil)
- Concomitant use with riociguat
- Marked bradycardia or tachycardia
- Aortic or mitral stenosis
- Pericardial tamponade, constrictive pericarditis
- Hypertrophic obstructive cardiomyopathy
Drug Interactions
Alcohol
Enhances hypotensive effects.
Riociguat
Significant hypotension. Absolutely contraindicated.
Dihydrallazine
Increased hypotensive effects.
PDE5 inhibitors (sildenafil, tadalafil, vardenafil)
Profound hypotension, collapse, and potentially death. Absolutely contraindicated.
Antihypertensives (beta-blockers, calcium channel blockers, ACE inhibitors, diuretics)
May potentiate hypotensive effects.
Storage
Store below 25°C (77°F). Do not freeze. Protect from direct sunlight and heat. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, reflex tachycardia, flushing, headache, palpitations, diaphoresis, nausea, vomiting, syncope, and methemoglobinemia (rare). Management involves elevating legs, intravenous fluids, and if necessary, alpha-adrenergic agonists (e.g., phenylephrine) for hypotension. For methemoglobinemia, methylene blue may be administered.
Pregnancy & Lactation
Pregnancy Category C. Use only if clearly needed and the potential benefits outweigh the potential risks to the fetus. It is unknown if glyceryl trinitrate is excreted in human milk; use with caution in nursing mothers.
Side Effects
Contraindications
- Hypersensitivity to glyceryl trinitrate or other nitrates
- Severe anemia
- Increased intracranial pressure
- Circulatory collapse and severe hypotension
- Concomitant use with phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil)
- Concomitant use with riociguat
- Marked bradycardia or tachycardia
- Aortic or mitral stenosis
- Pericardial tamponade, constrictive pericarditis
- Hypertrophic obstructive cardiomyopathy
Drug Interactions
Alcohol
Enhances hypotensive effects.
Riociguat
Significant hypotension. Absolutely contraindicated.
Dihydrallazine
Increased hypotensive effects.
PDE5 inhibitors (sildenafil, tadalafil, vardenafil)
Profound hypotension, collapse, and potentially death. Absolutely contraindicated.
Antihypertensives (beta-blockers, calcium channel blockers, ACE inhibitors, diuretics)
May potentiate hypotensive effects.
Storage
Store below 25°C (77°F). Do not freeze. Protect from direct sunlight and heat. Keep out of reach of children.
Overdose
Symptoms include severe hypotension, reflex tachycardia, flushing, headache, palpitations, diaphoresis, nausea, vomiting, syncope, and methemoglobinemia (rare). Management involves elevating legs, intravenous fluids, and if necessary, alpha-adrenergic agonists (e.g., phenylephrine) for hypotension. For methemoglobinemia, methylene blue may be administered.
Pregnancy & Lactation
Pregnancy Category C. Use only if clearly needed and the potential benefits outweigh the potential risks to the fetus. It is unknown if glyceryl trinitrate is excreted in human milk; use with caution in nursing mothers.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacture. Discard 6 months after first opening or by expiration date, whichever comes first.
Availability
Pharmacies, hospitals, clinics
Approval Status
Approved by major regulatory bodies (e.g., FDA, EMA, DGDA)
Patent Status
Generic available (Patent expired for Glyceryl Trinitrate)
WHO Essential Medicine
YesClinical Trials
Extensively studied for its efficacy in acute angina relief and prevention. Clinical trials consistently demonstrate rapid onset of action and significant reduction in anginal pain.
Lab Monitoring
- Blood pressure monitoring
- Heart rate monitoring
Doctor Notes
- Emphasize the critical contraindication with PDE5 inhibitors to all patients.
- Instruct patients on proper spray technique to ensure efficacy.
- Advise patients to seek immediate medical attention if pain persists after 3 sprays in 15 minutes, as it may indicate an MI.
Patient Guidelines
- Sit down before using the spray to avoid dizziness or fainting.
- Do not shake the canister before use.
- Do not test spray into the air if it's the first time or if not used recently, as this may deplete doses.
- Spray directly onto or under the tongue, do not inhale.
- Keep lips closed after spraying.
- Do not swallow immediately.
- If angina pain persists after 3 sprays in 15 minutes, seek emergency medical help.
Missed Dose Advice
This medicine is typically used on an as-needed basis for acute angina. If used prophylactically before an activity, and a dose is missed, simply take it before the planned activity. Do not take extra doses.
Driving Precautions
May cause dizziness or lightheadedness, especially at the start of treatment or with dose adjustments. Patients should avoid driving or operating machinery if they experience these symptoms.
Lifestyle Advice
- Avoid activities that trigger angina.
- Maintain a healthy diet and regular exercise.
- Manage stress.
- Quit smoking.
- Limit alcohol intake.
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