Nitromint tablets 2.6mg Egis Pharma treat coronary artery disease, angina (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Nitroglycerin

Ingredient

Composition information	Content
Nitroglycerin	2.6mg

Uses

Indications

Nitromint 2.6mg drugs are indicated in the following cases:

Long -term treatment of coronary artery disease and prevent angina.

Mechanism of action

nitroglycerin, the active ingredient of nitromint tablets, acts on the smooth muscle components of the blood vessel wall, expands peripheral veins and is inferior to the arteries and coronary arteries. Due to the effect of venous expansion, increased venous capacity, while blood vessels, left ventricular volume, at the end of the diastolic period and the trucks decrease. Because the small arteries expand, the peripheral resistance decreases and the rear load also decreases. All of these effects lead to less working heart and lower oxygen demand.

nitroglycerin expands the coronary artery under the pericardium and reduces coronary spasms. Through these effects and due to the decrease in the load, the blood flow to the heart is more evenly, the circulation of the system, along with the perfusion of ischemic areas and the subordinate area in the heart is improved. Under the effect of nitroglycerin, the efficiency of the heart and exercise tolerance is increased.

The effect of nitroglycerin on blood vessels is based on the creation of nitrogen oxide. Nitroglycerin and its active metabolites are biological conversion in the walls to produce nitrogen oxide (NO), an identical compound with the element of reducing endogenous endothelial tension. By activating guanyylate-Cyclase and increasing the formation of GMP ring. Due to preventing calcium ions from entering the cell, and increasing the elimination of calcium ions from the cell, the accumulation of CGMP reduces the calcium ionic concentration in the smooth muscle components of the vascular wall, resulting in the smooth muscle component of the blood vessels, which means the blood vessels. The vascular stretching effects of nitroglycerin occur in both intact and damaged endothelial.

Nitromint slow release is a prolonged release. Production technology ensures the active ingredient is continuously released from tablets and is absorbed by the digestive system slowly and evenly.

Nitrate's effect time is about 6 - 8 hours.

Dynamic pharmacokinetics

nitroglycerin absorbed at the digestive system, strongly metabolized in the liver (the first passing effect). 60% of the original drug is attached to plasma proteins. Nitroglycerin is rapidly metabolized in the liver (and also in other cells). The half -life is about 2 to 4 minutes.

Biological transformation produces a number of metabolites including two pharmacological active compounds (1,2- and 1.3-glyceryl-dinitrate) with a half-life of about 40-90 minutes.

The last elimination line is through the kidneys and then into the urine.

Before taking Nitromint tablets 2.6mg Egis Pharma treat coronary artery disease, angina (3 blisters x 10 tablets)

How to use

Take oral use.

Dosage

Dosage used for each patient, based on the severity of the disease and patient condition.

Normal starting dose is a slow -releasing compressor nitromint 2.6mg, twice a day; The dose can be increased by 2 or 3 nitromint slow release tablets 2.6mg, twice a day. Must take medicine twice a day, in the morning and early afternoon. If the pain occurs mainly at night, the daily dose must be taken in the morning and when going to bed.

Use disproportionate dosage to ensure low nitrate content in blood for a period of 8 to 12 hours a day, important for delaying or preventing nitrate tolerance.

Should take medicine before meals, drink whole tablets with some water, do not chew the pill.

Special patients

There is a high risk of posture hypotension in elderly patients, so low doses must be used when starting and increasing the dose slower in these patients.

Safety and effectiveness of drugs in children has not been proven.

According to the information obtained, the adjustment of the dose is not necessary when liver failure and/or renal failure.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose?

Symptoms

In case of overdose, symptoms are thought to be more severe side effects. Depending on the severity of the overdose, the hypotension occurs (with posture blood pressure regulatory disorders), vascular collapse, fainting, reflective tachycardia, headache, weak, dizziness, blurred vision, irritation, confusion, sleep, redness, nausea, vomiting and diarrhea. High doses can cause cyanosis, shortness of breath and fast breathing and convulsions. Very high doses can cause increased pressure in the skull.

Long -term overdose may increase methhemoglobin levels.

Overdose treatment

Smoking the substances in the stomach, gastric lavage in the early stages of overdose.

General measures include patients on their backs, high foot, monitoring signs of survival and adjustment if necessary in concentrated care conditions.

Lower blood pressure and/or shock need support for support. In the exception, Noradrenaline intravenous and/or dopamine intravenous need to recover.

In the case of methhaemoglobin-huye, depending on the weight, the following antidote can be used:

vitamin C, 1g oral or sodium salt in the vein.

green methylene, maximum 50ml of 1%solution, intravenous line.

green toluidine, only in intravenous lines, at first dose 2 - 4ml/kg weight; If necessary, it is possible to repeat treatment at a distance of 1 hour at a dose of 2ml/kg of weight.

Therapy with oxygen, hemolysis, blood change.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using nitromint 2.6mg, you may experience unwanted effects (ADR).

headache (nitrate headache) is common in the early stages of treatment. The degree of headache depends on the dose used and may end after a few days without the need to stop the drug (if necessary, the painkiller can be used, in case of a decrease in the dose, which can increase the dose slowly and gradually increase later). Rarely have just started to use the drug or when increasing the dose causes hypotension, or the posture lower blood pressure appears with symptoms of increased heart rate, dizziness, dizziness, feeling weak. Rarely occurs nausea, vomiting. In some special cases, excessive hypoglycemia can worsen the symptoms of angina. Sulfal, 3 times a day (morning, noon, afternoon) can lead to nitrate tolerance, and diagonal tolerance with other nitrate derivatives.

When experiencing the side effects of the drug, it is necessary to stop using and notify the doctor the unwanted effects when using the drug or the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

Nitromint drugs 2.6mg contraindicated in the following cases:

Hypersensitivity to nitroglycerin or any other organic nitrate compound.

Low blood pressure (systolic blood pressure below 90mmHg).

Acute circulation (shock, vascular collapse).

Cardiomic shock (unless the pressure at the end of the centrifugal is guaranteed appropriately thanks to the pump ball in the aorta or by positive muscle contraction drugs).

Acute myocardial infarction with low pump pressure.

Hypertorn, obstruction of myocardial disease.

Reducing blood volume.

Aortic valve stenosis and mitral valve.

Inflammation, pericardial compression.

Easy to have circulatory disorders when standing.

Head injury, skull bleeding or skull -increased increased condition (although only after using nitroglycerin intravenous sugar can see more pressure in the skull).

Clinical severe anemia.

Narrow -angle glaucoma (nitrate may increase the pressure in the eye).

Due to the effect on the metabolism of nitrogen monoxide/guanosine monophosphate (CGMP), phosphodiesterase inhibitors (such as Sildenafil, Vardenafil, Tadalafil) can add force with the effect of lowering the blood pressure of nitrate, so it prevents indicating the use of these inhibitors and nitrogen compounds. monoxide with nitrate.

Safety and effectiveness of drugs in children has not been proven.

Be cautious when used

The drug is not suitable for treating acute angina. In this case, the drugs should be used immediately.

Like other nitrate compounds, patients who are using nitroglycerin therapy for a long time when they need to switch to another drug should reduce and stop nitroglycerin slowly.

Due to relative blood flow in poor ventilation areas, nitroglycerin reduces the concentration of oxygen in artery blood. In patients with coronary artery disease, this can reduce myocardial circulation, and cause myocardial ischemia. Therefore, it is necessary to be careful when taking medication for patients with heart disease or hypoxemia in the artery.

Elderly people are at high risk of posture hypotension, so the starting dose must be lower and the increased dose is slower in elderly patients.

Need to use especially when using nitroglycerin for patients with severe liver disease and/or kidney, thyroid disobsk, mitral valve, low body temperature and poor nourishment and recently have myocardial infarction.

During treatment, the percentage of angina will increase during the low nitrate concentration stage. A complementary treatment may be needed with another anti -angina drug that has another active ingredient to avoid pain.

Avoid using alcoholic drinks during treatment will lead to severe headaches, hypotension or vascular collapse.

In each 2.6 mg nitromint release tablet, there are 23.4 mg lactose, so it must be paid to this when there is a lack of lactase enzymes, galactose - blood and syndrome with poor absorption of glucose/ galactose.

The ability to drive and operate machinery

Especially when starting treatment, the drug can reduce the ability to drive and operate machinery. Therefore, when starting to use the drug, it is not allowed to drive or operate machinery - for a while depending on the case. After that, the limit must be decided by the doctor for each case.

Pregnancy

Prelise Clinical data: It has been seen to cause teratogenic and mutations.

Human data: There is no nitrate harmful data on pregnancy and breastfeeding.

Because the safety of nitroglycerin in these cases has not been proven, it is not allowed to take the drug during pregnancy (especially in the first 3 months of pregnancy), unless it is more beneficial than harmful.

The period of breastfeeding

Because the safety of nitroglycerin in these cases has not been proven, it is not allowed to take the drug during breastfeeding, unless it is more beneficial than harmful.

Interactive drug

Simultaneously used with vasoconstrictors, hypertension drugs, beta -blockers, calcium channel blockers, diuretics, sedatives or 3 -round antidepressants, and alcohol can increase the anti -hypertension effect of nitroglycerin.

Patients who had previously used organic nitrate compounds (such as isosorbid mono - or Dinitrate) may need higher dose of nitroglycerin to achieve the same hemodynamic effect. If used simultaneously with dihydroergotamine, nitroglycerin increases the content of dihydroergotamine in the blood, which means increasing the vasoconstriction effect of dihydroergotamine (ie hypertension and ischemia).

Nitroglycerin common use with heparin reduces the effect of heparin.

Phosphodiesterase inhibitors (such as Sildenafil, Vardenafil, Tadalafil) can be plus with nitrate's anti -hypertension effect. If used in combination, it can lead to deadly cardiovascular complications, thus contraindicated to use these drugs.

Laxatives can shorten the time in the intestines of the nitromint slow release tablet, thereby reducing the absorption and concentration of nitroglycerin in plasma.

Cavalry: Not applicable.

Storage

Store drugs in dry place, at temperatures below 25 ° C, avoid direct light.

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