Comparison of the effectiveness of Nitrocor and Nitroglycerin
Nitrocor is more effective than Nitroglycerin - this means that the ability of the medicinal substance to provide the maximum possible effect is different.
For example, if the therapeutic effect of Nitrocor is more pronounced, then it is impossible to achieve this effect with Nitroglycerin, even in large doses.
Also, the speed of therapy is an indicator of the speed of the therapeutic action; Nitrocor and Nitroglycerin are also different, as is bioavailability - the amount of a medicinal substance reaching the place of its action in the body. The higher the bioavailability, the less it will be lost during absorption and use by the body.
Nitrocore
The domestic drug nitrocor (active ingredient nitroglycerin) is a peripheral vasodilator that affects mainly the vessels of the venous bed. Has an antianginal (anti-ischemic) effect. The mechanism of action is based on the release of the active substance NO (nitric oxide) in the smooth muscle choroid. Nitric oxide activates guanylate cyclase and increases the concentration of cyclic guanosine monophosphate, which ultimately causes smooth muscle relaxation. Nitrocor reduces the heart's need for oxygen. This occurs due to an increase in the lumen of the peripheral veins, a decrease in the volume of blood entering the right atrium (reduction in preload), and a decrease in total peripheral vascular resistance (reduction in afterload). The drug promotes more intensive blood supply to ischemic areas of the myocardium. While taking nitrocor, exercise tolerance improves in patients suffering from coronary heart disease and angina pectoris. In chronic heart failure, it partially relieves the myocardium (primarily by reducing preload). Reduces pressure in the pulmonary circulation. After oral administration, it is absorbed in the gastrointestinal tract, subsequently undergoing first-pass metabolism in the liver. The effect of the first pass through the liver can be neutralized by taking nitrocor sublingually: in this case, the therapeutic concentration of the active substance in the blood will be achieved in just a few minutes. The half-life of the drug when taken orally is 4 hours, when administered sublingually - 20 minutes. Nitrocor is excreted mainly by the kidneys.
The doctor sets the dose and regimen of pharmacotherapy individually, taking into account the indications and the specific clinical picture. Despite the absence of direct contraindications, patients with severe cerebral atherosclerosis, cerebral circulation disorders, severe anemia, hypovolemia, and a tendency to orthostatic (postural) hypotension should take Nitrocor with extreme caution.
With long-term pharmacotherapy, it is possible to develop resistance to the action of nitrocor (which is true for all nitrates). To prevent loss of effectiveness of the drug, it is recommended to maintain a 10-12 hour interval in their use during each daily cycle. During treatment you should refrain from consuming ethanol. When used together with other vasodilators, angiotensin-converting enzyme inhibitors, calcium antagonists, beta-blockers, thiazide diuretics, monoamine oxidase inhibitors, tricyclic antidepressants, alcohol-containing drugs, the hypotensive effect of nitrocor may be potentiated. Beta-blockers and calcium antagonists enhance the antianginal effect of the drug. Sympathomimetics, on the contrary, can reduce the antianginal effect of nitrocor (however, the latter does not stand aside and also inhibits the pressor effect of sympathomimetics). When combining nitrocor with drugs that have anticholinergic activity, there is a decrease in saliva secretion. There is evidence that aspirin, taken as an analgesic, increases the concentration of nitroglycerin in the blood plasma, as a result of which the hypotensive effect may be enhanced, accompanied by headaches. Some sources provide evidence of a decrease in the vasodilatory effect of nitrocor during long-term aspirin therapy. It is also believed that nitroglycerin (Nitrocor) may enhance the antiplatelet effect of aspirin. When used together, Nitrocor weakens the therapeutic effect of acetylcholine, histamine, and norepinephrine. When combining the drug with procainamide, there is a possibility of potentiation of the hypotensive effect up to the development of collapse.
Comparison of the safety of Nitrocor and Nitroglycerin
The safety of a drug includes many factors.
At the same time, in Nitrocor it is quite similar to Nitroglycerin. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Nitrocor, as well as Nitroglycerin, we look at which organ is the metabolizing organ and how critical the effect on it is.
The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Nitrocor does not have any risks when used, just like Nitroglycerin.
Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Nitrocor and Nitroglycerin.
Nitrocor sublingual tablets 0.5 mg No. 40
Name
Nitrocor.
Release forms
Pills.
INN
Nitroglycerine.
FTG
Vasodilator; nitrate.
Compound
per tablet: active substance: nitroglycerin - 0.500 mg
in the form of nitroglycerin with lactose - 5,000 mg
; excipients: aspartame - 0.002 mg, colloidal silicon dioxide (Aerosil) - 0.900 mg, stearic acid - 0.400 mg, croscarmellose sodium - 1.000 mg, potato starch - 2.600 mg, microcrystalline cellulose - 35.098 mg.
Description
Tablets are white or almost white, flat-cylindrical, with a bevel. Pharmacotherapeutic group Peripheral vasodilators used in the treatment of heart diseases. Organic nitrates. ATX CODE:
C01DA02
.
Pharmacological properties
Pharmacodynamics
Peripheral vasodilator with a predominant effect on venous vessels. The effect of nitroglycerin is mainly associated with a decrease in myocardial oxygen demand due to a decrease in preload (dilation of peripheral veins and a decrease in blood flow to the right atrium) and afterload (reduction in total peripheral vascular resistance). It has a central inhibitory effect on the sympathetic tone of blood vessels, inhibits the vascular component of the formation of pain. Causes dilation of meningeal vessels, which explains the headache when using it. When using the drug sublingually, an attack of angina usually stops after 1.5 minutes, the hemodynamic and antianginal effect lasts from 30 to 60 minutes.
Pharmacokinetics
Quickly and completely absorbed from the surface of the mucous membranes. When taking the drug under the tongue in a dose of 0.5 mg, nitroglycerin immediately enters the systemic bloodstream. The maximum concentration in blood plasma is reached after 5 minutes. The drug has a large volume of distribution. The connection with blood plasma proteins is 60%. Rapidly metabolized with the participation of nitrate reductase, with the formation of di- and mononitrates. Excreted by the kidneys in the form of metabolites.
Indications for use
Relief and short-term prevention of angina attacks.
Contraindications
Hypersensitivity to the active substance, nitrates and any of the excipients, shock, collapse, age under 18 years (efficacy and safety have not been established for ages under 18 years), hereditary lactose intolerance, lactase deficiency, glucose-galactose malabsorption syndrome and phenylketonuria, use phosphodiesterase 5 inhibitors (sildenafil, tadalafil, vardenafil) during the previous 24-48 hours, severe anemia, angle-closure glaucoma with high intraocular pressure, increased intracranial pressure (including with hemorrhagic stroke, after a recent head injury), arterial hypotension (systolic blood pressure below 100 mm Hg, diastolic blood pressure below 60 mm Hg), bradycardia (less than 50 beats/min), obstructive hypertrophic cardiomyopathy, cardiac tamponade, toxic pulmonary edema, severe mitral or aortic stenosis, joint use of the soluble guanylate cyclase stimulator riociguat.
Precautionary measures
The drug is recommended to be used with caution (balancing risk and benefit) in hyperthyroidism, conditions accompanied by a decrease in left ventricular filling pressure (acute myocardial infarction, isolated mitral stenosis, constrictive pericarditis), idiopathic hypertrophic subaortic stenosis, cerebrovascular accident, severe renal and/or hepatic insufficiency (risk of developing methemoglobinemia). While taking Nitrocor® tablets, a significant decrease in blood pressure and the appearance of dizziness may occur when suddenly moving to a vertical position from a “sitting” or “lying down” position; Drinking alcohol, exercising, and hot weather. With Nitrocor®, as with other organic nitrates, with frequent use, addiction may develop, requiring an increase in dosage. If blurred vision or dry mouth persists or is severe, treatment should be discontinued. The severity of headache while taking Nitrocor® can be reduced by reducing its dose and/or simultaneous administration of validol. In case of tolerance development, which is expressed in a decrease in the duration and severity of the effect, it is recommended to replace nitrates with antianginal drugs of other groups for some time. After a break in treatment, sensitivity to nitrates is restored. The tablet should not be chewed or swallowed. During the treatment period, it is not recommended to visit the bathhouse, sauna, or drink alcohol. To prevent hypotension, it is recommended to take nitroglycerin while lying down or sitting with your legs elevated. Taking nitroglycerin in a standing position can not only contribute to fainting, but also weaken the antianginal effect and develop the “steal” syndrome (increased myocardial ischemia), especially in patients with widespread atherosclerosis of the coronary vessels. The storage conditions of the drug should be strictly observed. If necessary, you can carry it with you, but it is not recommended to store the tube close to your body. After use, the tube must be tightly closed with a lid. If the integrity of the packaging or storage conditions is violated, the effectiveness of the drug may decrease; in this case, it is recommended to take a new package.
Impact on the ability to drive vehicles and machinery
When driving vehicles and operating machinery that require increased attention, it should be borne in mind that taking Nitrocor® can lead to a decrease in motor and mental reaction. Features of use in the elderly When using nitrates in elderly people, the risk of developing such adverse reactions as hypotension and fainting increases. This category of patients is recommended to take the drug with caution, if possible, in a sitting or lying position. Use during pregnancy and breastfeeding is possible only for health reasons. Children The safety and effectiveness of use in children have not been established; therefore, the use of the drug in this category of patients is not recommended.
Directions for use and doses
Nitrocor® is recommended to be used as prescribed by a doctor. Nitrocor® should be taken immediately at the first signs of an angina attack: 1 Nitrocor® tablet is placed under the tongue and held until completely dissolved, without swallowing. The usual dose of the drug is 1 tablet under the tongue. If the angina attack is not stopped within 5 minutes, you must take 1 more Nitrocor® tablet. If there is no therapeutic effect after taking 2-3 tablets, given the likelihood of developing myocardial infarction, you should immediately call a doctor. For frequent attacks of angina, it is advisable to use long-acting nitroglycerin preparations. To prevent an attack of angina during physical activity or in situations that may provoke an attack, take 1 tablet sublingually immediately before the expected exercise.
Side effect
From the central nervous system: “nitrate” headache (especially at the beginning of the course of treatment, decreases with continued therapy), dizziness and a feeling of weakness, anxiety, psychotic reactions, lethargy, disorientation, cerebral ischemia. From the cardiovascular system: decreased blood pressure; tachycardia, rarely (especially with overdose) - orthostatic collapse, cyanosis, redness of the facial skin, bradycardia, increased symptoms of angina pectoris (paradoxical reaction to nitrates). From the gastrointestinal tract: dry mouth, nausea, vomiting, abdominal pain, heartburn, halitosis, burning sensation in the mouth. From the organ of vision: increased intraocular pressure, blurred vision. From the blood and lymphatic system: methemoglobinemia. From the immune system: allergic reactions (exfoliative dermatitis, rash).
Overdose
Symptoms: decreased blood pressure (below 90 mmHg) with orthostatic dysregulation, severe dizziness, headache, fainting, shortness of breath, severe weakness, rapid heartbeat, increased body temperature, convulsions, asthenia, drowsiness. When using high doses (more than 20 mcg/kg) - collapse, cyanosis, methemoglobinemia, dyspnea and tachypnea. If symptoms of overdose appear, immediately lay the patient down, elevate his legs and immediately call a doctor.
Interaction with other drugs
The hypotensive effect of the drug may be excessive in case of uncontrolled simultaneous use of vasodilators, antihypertensive drugs, angiotensin-converting enzyme (ACE) inhibitors, phosphodiesterase inhibitors, slow calcium channel blockers, tricyclic antidepressants, alcohol, diuretics, beta-blockers, monoamine oxidase inhibitors (MAOIs) ), procainamide. Administration with dihydroergotamine may lead to an increase in its content in the blood and an increase in blood pressure (due to an increase in the bioavailability of dihydroergotamine). The simultaneous administration of Nitrocor® and heparin reduces the effectiveness of the latter (after discontinuation of the drug, a significant decrease in blood clotting is possible, which may require a reduction in the dose of heparin). Atropine and other drugs that have an M-anticholinergic effect, reducing the secretion and bioavailability of nitroglycerin, may reduce its effectiveness. Alpha adrenergic agonists, histamine, pituitrin, corticosteroids, central nervous system stimulants, bee and snake venom, excessive insolation reduce the antianginal effect of nitroglycerin. Salicylates increase the level of nitroglycerin in the blood, barbiturates accelerate its metabolism. Donators of sulfhydryl groups (captopril, acetylcysteine, unithiol) restore reduced sensitivity to nitroglycerin.
Release form
Sublingual tablets 0.5 mg. 40 tablets in a polymer case with a polyethylene stopper. The pencil case along with the insert is placed in a cardboard pack.
Storage conditions
Store at a temperature not exceeding 25 °C, away from fire. Keep out of the reach of children.
Best before date
2 years. Do not use after the expiration date stated on the packaging.
Conditions for dispensing from pharmacies
Over the counter.
Buy Nitrocor sublingual tablets 0.5 mg No. 40 in the pharmacy
Price for Nitrocor sublingual tablets 0.5 mg No. 40
Instructions for use for Nitrocor sublingual tablets 0.5 mg No. 40
Comparison of addiction between Nitrocor and Nitroglycerin
Like safety, addiction also involves many factors that must be considered when evaluating a drug.
Thus, the totality of the values of such parameters as “syndrome o” in Nitrocor is less than the similar values in Nitroglycerin. Withdrawal syndrome is a pathological condition that occurs after the cessation of intake of addictive or dependent substances into the body. And resistance is understood as initial immunity to a drug; in this it differs from addiction, when immunity to a drug develops over a certain period of time. The presence of resistance can only be stated if an attempt has been made to increase the dose of the drug to the maximum possible.
Comparison of side effects of Nitrocor and Nitroglycerin
Side effects or adverse events are any adverse medical event that occurs in a subject after administration of a drug.
Nitrocor's side effects are almost the same as Nitroglycerin's. They both have few side effects. This implies that the frequency of their occurrence is low, that is, the indicator of how many cases of an undesirable effect of treatment are possible and registered is low. The undesirable effect on the body, the strength of influence and the toxic effect of Nitrocor are similar to Nitroglycerin: how quickly the body recovers after taking it and whether it recovers at all.
Nitroglycerin Nitrocor tablet podjaz 0.5 mg x40
Trade name: Nitrocor International name: Nitroglycerin
Release form: sublingual tablets 0.5 mg (test tubes, polymer tubes)
Composition: nitroglycerin with lactose 500 mcg [in terms of nitroglycerin]
Pharmacological group: vasodilating agent - nitrate
Pharmacological group according to ATK: C01DA02 (Nitroglycerin)
Pharmacological action: antianginal, venodilating, nitrate, antispasmodic,
Indications: IHD: angina pectoris (treatment, prevention), myocardial infarction (rehabilitation). For intravenous administration - acute myocardial infarction (including complicated by acute LV failure), unstable and post-infarction angina, pulmonary edema, angina pectoris (refractory to other types of therapy), controlled hypotension during surgery to reduce bleeding in surgical field, occlusion of the central retinal artery.
Dosage regimen: Orally, sublingually, buccally. Relief of angina pectoris. Sublingually (the tablet or capsule is kept under the tongue until completely absorbed, without swallowing), immediately after the onset of pain - 0.5-1 mg per dose. If necessary, to achieve a faster effect, the capsule should be immediately crushed with teeth; the capsule can be repeated after 30-40 minutes. In many patients with stable angina, the effect occurs with a smaller dose (1/2-1/3 tablets), therefore, if the pain goes away quickly, it is recommended to spit out the remainder of the tablet that has not had time to dissolve. Typically, the antianginal effect appears within 0.5-2 minutes, 75% of patients note improvement within the first 3 minutes, and another 15% within 4-5 minutes. If there is no antianginal effect, another 0.5 mg of nitroglycerin should be taken during the first 5 minutes. If there is no therapeutic effect after taking 2-3 tablets, you should immediately call a doctor. Duration of action after sublingual administration is about 45 minutes. For frequent attacks of angina, it is advisable to prescribe prolonged forms of nitrates. If an angina attack develops during treatment with long-acting nitrates, nitroglycerin must be taken sublingually to stop the acute attack. Tolerance to sublingual forms of nitroglycerin develops infrequently, however, if it occurs in some patients, the dose of the drug must be gradually increased, bringing it to 2-3 tablets. To prevent angina pectoris, take it orally with water before meals. In mild cases - 1-2 tablets of 2.9 mg 2-3 times a day. In more severe cases - 1-2 tablets of 5.2 mg 2-3 times a day. The maximum daily dose is 34.8 mg. Due to the fact that the bioavailability of nitroglycerin from retard tablets is low, it is recommended, if well tolerated, to take 1-3 tablets at a time regularly 3-4 times a day or periodically, 30-40 minutes before the expected physical activity. If the therapeutic effect is insufficient, the dose can be gradually increased (but not more than 2 tablets per dose), and after the onset of a therapeutic effect, it can be reduced. 1% solution for sublingual use: relief of an attack - 1-2 drops sublingually or 2-3 drops applied to a small piece of sugar and keep it in the mouth, without swallowing, until completely absorbed. Buccal: a plate with a selected dose of nitroglycerin is glued to the oral mucosa, usually in the upper gum area above the canines or small molars. To do this, simply press the plate with your finger against the oral mucosa for a few seconds. The action occurs almost immediately and lasts 3-4 hours or more. Aerosol, spray for sublingual use: to relieve an attack of angina - 0.4-0.8 mg (1-2 doses), pressing the dosing valve, preferably in a sitting position, while holding your breath at intervals of 30 seconds, then close your mouth for a few seconds . If necessary, repeat administration, but not more than 1.2 mg (3 doses) over 15 minutes. To prevent the development of an attack - 0.4 mg (1 dose) 5-10 minutes before exercise. In case of acute LV failure, developing pulmonary edema - 1.6 mg (4 doses) or more in a short period of time (under strict medical supervision).
Contraindications: Hypersensitivity, simultaneous use of sildenafil.
Side effects: From the cardiovascular system: dizziness, headache, tachycardia, skin flushing, fever, decreased blood pressure, rarely (especially in case of overdose) - orthostatic collapse, cyanosis. From the digestive system: dry mouth, nausea, vomiting, abdominal pain. From the side of the central nervous system: rarely (especially in case of overdose) - anxiety, psychotic reactions, lethargy, disorientation. Allergic reactions: rarely - skin rash, itching. Local reactions: skin hyperemia, skin itching, burning, allergic contact dermatitis. Other: blurred vision, weakness, hypothermia, methemoglobinemia. Overdose. Symptoms: decreased blood pressure (below 90 mm Hg) with orthostatic dysregulation, reflex tachycardia, headache, asthenia, dizziness, increased drowsiness, feeling of heat, nausea, vomiting may develop when used in high doses (more than 20 mg/kg ) - collapse, cyanosis, methemoglobinemia, dyspnea and tachypnea. Treatment: with intravenous administration, stop further administration; with transdermal administration, remove the remaining ointment or patch. The head end of the bed should be lowered and the patient's legs should be raised. As a rule, blood pressure normalizes within 15-20 minutes after stopping the administration of nitroglycerin, then administration can be continued after reselecting the infusion rate. To correct blood pressure, it is possible to use phenylephrine and other vasoconstrictors. For methemoglobinemia, depending on the severity, intravenous ascorbic acid (in the form of sodium salt), methylthioninium chloride (methylene blue) 0.1-0.15 ml/kg of 1% solution (up to 50 ml), oxygen therapy, hemodialysis, and exchange transfusion are prescribed.
Pharmacodynamics: Venodilating agent from the nitrate group. Nitrates are capable of releasing nitric oxide from their molecule, which is a natural endothelial relaxing factor - a mediator of direct activation of guanylate cyclase. An increase in cGMP concentration leads to relaxation of smooth muscle fibers (mainly venules and veins). It has an antianginal and antispasmodic effect, relaxes the smooth muscles of the vascular walls, bronchi, gastrointestinal tract, biliary tract, and ureters. When administered intravenously, it causes a rapid decrease in preload on the heart due to the expansion of peripheral veins. Reduces blood flow to the right atrium, helps reduce pressure in the “lesser” circulation and regression of symptoms in pulmonary edema, reduces afterload, myocardial oxygen demand (by reducing preload, afterload and tension of the ventricular walls due to a decrease in heart volume). Promotes redistribution of coronary blood flow in areas with reduced blood circulation. It has a central inhibitory effect on the sympathetic tone of blood vessels, inhibiting the vascular component of the formation of pain. Causes dilatation of cerebral vessels, which explains headaches when using it. With prolonged or frequent use of long-acting nitrates, tolerance to the drug develops (weakening of the therapeutic effect). After a break, sensitivity is restored. In order to prevent the development of tolerance, it is recommended to maintain a daily, preferably nightly, “nitrate-free interval” for 8-12 hours. In most patients, such therapy is more effective than continuous treatment. When used in sublingual and buccal forms, an attack of angina is eliminated after 1.5 minutes, the hemodynamic and antianginal effect persists for up to 30 minutes and 5 hours, respectively. When applying the ointment, the antianginal effect is observed after 15-60 minutes and lasts 3-4 hours. In tablets, retard can prevent the development of attacks. After oral administration, nitroglycerin in the small intestine is gradually released from the capsule and absorbed, the effect occurs 30-60 minutes after administration and lasts 4-6 hours (during this period, it is converted into inactive metabolites in the liver). TTS is a flat multilayer system that, after attaching the patch to the skin, provides continuous release of nitroglycerin through a permeable membrane that regulates the rate of its release from the drug reservoir. The active substance gradually penetrates the blood vessels of the skin, which ensures its circulation in the circulatory system in relatively constant concentrations during the period of time recommended for application. After 12 hours, TTC releases 10% of the initial nitroglycerin content. Since the same amount of nitroglycerin is constantly released from the TTC on each square cm of surface, the dose received by the patient depends solely on the size of the contact surface of the system. Continuous TTC therapy can be carried out in those patients in whom the clinical effect of the drug remains virtually unchanged over a long period of time. The effect when using TTC occurs within 0.5-3 hours and lasts up to 8-10 hours.
Pharmacokinetics: Quickly and completely absorbed from the surface of mucous membranes and through the skin. When taken orally, bioavailability is no more than 10% compared to nitroglycerin administered sublingually (the “first pass” effect through the liver). With sublingual, buccal and intravenous administration, “primary” hepatic degradation is excluded - nitroglycerin immediately enters the systemic bloodstream. When administered sublingually at a dose of 0.5 mg, bioavailability is 100%, TCmax is 5 minutes. Has a very large volume of distribution. Communication with plasma proteins - 60%. It is quickly metabolized with the participation of nitrate reductase, with the formation of di- and mononitrates (only isosorbide-5-mononitrate is active), the final metabolite is glycerol. Excreted by the kidneys in the form of metabolites. The total clearance is 25-30 l/min, and T1/2 is 4-5 minutes. With intravenous administration, T1/2 is 1-3 minutes, total clearance is 30-78 l/min. 2 hours after application of one TTC patch, the concentration of nitroglycerin in plasma is achieved, which remains for the recommended period of use. The plasma concentration is directly dependent on the contact surface area of the TTC and is practically independent of the site of application of the patch (skin of the chest, shoulder or abdomen). Repeated applications of TTC do not lead to the accumulation of nitroglycerin. The active substance is rapidly metabolized in the liver by glutathione reductase, which acts on organic nitrates. In addition, nitroglycerin is metabolized in erythrocytes using enzymatic reactions that occur with the participation of sulfhydryl radicals, as well as through interaction with reduced Hb. Due to the short T1/2, during the first hour after removal of TTS, the concentration of nitroglycerin in plasma falls below the detection limits.
Special instructions: In case of acute myocardial infarction or acute HF, it should be used only under the condition of careful monitoring of the patient. To prevent an increase in angina attacks, abrupt withdrawal should be avoided. The TTS must be removed before cardioversion or defibrillation. When using TTS, to relieve an attack of angina, you should additionally use fast-acting nitrates. The patch should not be applied to the scalp. To prevent an undesirable decrease in blood pressure, the rate of drug administration should be individually and methodically correct (see above). A decrease in blood pressure can be observed not only during the period of selecting the rate of nitroglycerin administration, but also later, against the background of initially stabilized blood pressure. Therefore, blood pressure monitoring should be carried out at least 3-4 times per hour throughout the entire duration of nitroglycerin infusion. Patients previously treated with organic nitrates (isosorbide dinitrate, isosorbide-5-mononitrate) may require a higher dose to obtain the desired hemodynamic effect. While taking nitroglycerin, there may be a significant decrease in blood pressure and the appearance of dizziness with a sharp transition to a vertical position from a “lying” or “sitting” position, when drinking ethanol, doing physical exercise and hot weather, as well as increased angina with a sharp decrease in blood pressure, ischemia, up to to myocardial infarction and sudden death (paradoxical nitrate reactions). With frequent use (without free intervals) addiction may develop, requiring an increase in dosage. The severity of headache while taking nitroglycerin can be reduced by reducing its dose and/or simultaneous administration of validol. If blurred vision or dry mouth persists or is severe, treatment should be discontinued. Some solutions for intravenous administration contain dextrose, which must be taken into account when used in patients with diabetes mellitus. During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions. Carefully. For all forms (comparing risk and benefit) - hemorrhagic stroke, intracranial hypertension, acute myocardial infarction with low LV filling pressure (risk of decreased blood pressure and tachycardia, which can increase ischemia), CHF with low LV filling pressure, glaucoma (risk of increased intraocular pressure ), severe anemia, thyrotoxicosis, arterial hypotension with low systolic blood pressure (can aggravate the condition, causing paradoxical bradycardia and angina attacks), HCM (possible increased frequency of angina attacks), severe renal failure, liver failure (risk of developing methemoglobinemia), pregnancy, lactation , age under 18 years (safety of use has not been established). For prolonged dosage forms for oral administration (additionally) - increased gastrointestinal motility, malabsorption syndrome. For intravenous administration (additionally): head injury (increases intracranial pressure), cardiac tamponade, constrictive pericarditis, hypovolemia (must be corrected before using nitroglycerin - the risk of a pronounced decrease in blood pressure). Category of action on the fetus. C
Interaction: Simultaneous use with sildenafil, vasodilators, antihypertensive drugs, ACE inhibitors, beta-blockers, BMCC, procainamide, tricyclic antidepressants, MAO inhibitors, PDE inhibitors, and ethanol enhances the hypotensive effect. Prescription with dihydroergotamine may lead to an increase in its concentration in the blood and to an increase in blood pressure (increased bioavailability of dihydroergotamine). The simultaneous administration of nitroglycerin and heparin reduces the effectiveness of the latter (after discontinuation of the drug, a reduction in the dose of heparin may be required).
Storage conditions: List B
Dispensed from pharmacies: Dispensed without a prescription
Drug registration number: LS-001302
Date of registration (re-registration) of the drug: 02/17/2006
Comparison of ease of use of Nitrocor and Nitroglycerin
This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.
The ease of use of Nitrocor is approximately the same as Nitroglycerin. However, they are not convenient enough to use.
The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.
Last update date: 2020-12-04 13:45:33
