Pharmacodynamics and pharmacokinetics
Pharmacodynamics
Nitroglycerin is a nitrogen-containing compound, a peripheral vasodilator with venodilating and antianginal effects .
The action of nitroglycerin is associated with the ability to release nitric oxide, which affects the endothelium, causing smooth muscle relaxation and vasodilation. As a result, preload (venous return) and afterload (resistance of the systemic vessels) are reduced. The load on the heart is reduced and the need for oxygen is reduced.
The simultaneous expansion of the coronary vessels significantly increases the delivery of oxygen to the heart muscle. A decrease in venous return leads to a decrease in pressure in the pulmonary circle, a decrease in the volume of the left ventricle and eliminates pulmonary edema .
Relaxes the smooth muscles of the gallbladder and ducts, bronchi, urinary tract, and intestines. The effect of the drug begins in 30-60 seconds and lasts from 10 to 30 minutes.
Pharmacokinetics
The aerosol is quickly absorbed from the oral cavity. Bioavailability 100%. Cmax in the blood is determined after 4 minutes. 60% binds to blood proteins. Binds to red blood cells.
Metabolized to form mononitrates and dinitrates. Metabolites are excreted by the kidneys. T1/2 is 2.5–4.5 minutes.
Contraindications
- shock;
- collaptoid states;
- increased sensitivity to nitrates;
- age up to 18 years.
Prescribed with caution for orthostatic hypotension , acute circulatory failure with blood pressure below 90 mm Hg. Art., hypertrophic cardiomyopathy , hemorrhagic stroke , severe renal and liver failure , anemia , epilepsy , acute myocardial infarction with a low degree of filling of the left ventricle, thyrotoxicosis , alcoholism, head injury, angle-closure glaucoma , migraine .
Contraindications to the use of the drug Nitromint
Aerosol Nitromint is not recommended for use when:
- hypersensitivity to organic nitrates;
- acute vascular insufficiency (shock, collapse);
- hypotension (systolic blood pressure ≤90 mm Hg);
- cardiogenic shock;
- angina caused by hypertrophic cardiomyopathy;
- pericardial cardiac tamponade;
- aortic and mitral stenosis;
- primary pulmonary hypertension;
- increased intracranial pressure due to intracerebral hemorrhage or trauma.
Instructions for use of Nitromint (Method and dosage)
The drug is sprayed under the tongue while holding the breath. Before first use, you need to fill the pump by pressing the valve until an aerosol appears. If the cylinder is not used often, the pump needs to be refilled.
When spraying the drug, the container is held vertically, head up. One click on the valve corresponds to 1 dose - 0.4 mg of nitroglycerin . There is no need to shake the container before use.
Aerosol Nitromint, instructions for use
During an attack of angina, the spray is sprayed in an amount of 1–2 doses (0.4–0.8 mg) in a sitting position, at intervals of 30 s. Then you need to close your mouth. Repeated administration - up to 3 doses in 15 minutes.
To prevent an attack, use 1 dose 10 minutes before exercise.
For pulmonary edema and left ventricular failure, use 4 doses or more in a short time, controlling blood pressure (systolic>100 mmHg).
In elderly people, the dosage regimen does not change.
Special instructions for the use of the drug Nitromint
In case of migraine and angle-closure glaucoma, Nitromint aerosol should be used with extreme caution and under medical supervision. During pregnancy, it is necessary to carefully assess the benefit/risk ratio before prescribing the drug. Aerosol Nitromint increases the urinary excretion of catecholamines and vanillylmandelic acid, and also contains ethanol. Its use can be dangerous in case of liver disease, alcoholism, epilepsy, brain injury, central nervous system diseases, and in childhood. Nitromint aerosol should not be used while smoking or near an open flame. When using the aerosol, a temporary burning sensation in the mouth may occur. The use of an aerosol may cause dizziness; this should be borne in mind when driving vehicles and operating machinery, especially at the beginning of treatment. Drinking alcoholic beverages during treatment with Nitromint is strictly prohibited.
Overdose
Overdose is manifested by symptoms: orthostatic hypotension , headache, sharp decrease in blood pressure, tachycardia , dizziness, vomiting, drowsiness, facial flushing, feeling of heat.
When taking high doses (20 mg/kg or more), methemoglobinemia , dyspnea , cyanosis , and collapse . Treatment: lay the patient down, placing the legs in an elevated position. In severe cases - administration of norepinephrine , replenishment of blood volume. Epinephrine is contraindicated.
Drug interactions Nitromint
Nitromint should be used with caution in combination with:
- antihypertensive drugs: β-adrenergic receptor blockers, calcium channel blockers - may increase the antihypertensive effect;
- tranquilizers (chlordiazepoxide, trimethocin, tofisopam) - may increase the antihypertensive effect;
- tricyclic antidepressants such as imipramine - may increase the antihypertensive effect;
- diuretics - the risk of developing hypotension;
- heparin - decreased effect of heparin;
- dihydroergotamine (the effect of dihydroergotamine increases).
It is not recommended to prescribe Nitromint in combination with sildenafil - there is a risk of developing hypotension. For patients who have previously used nitrates (isosorbide dinitrate, isosorbide mononitrate), Nitromint aerosol is prescribed in high doses (reduced effect of nitroglycerin due to binding to nitrates).
Interaction
Vasodilators , ACE inhibitors , beta-blockers , CCBs , antipsychotics , antidepressants , MAO inhibitors , Procainamide and phosphodiesterase inhibitors enhance the hypotensive effect of the drug.
Simultaneous administration of ACC and ethanol enhances the vasodilating effect.
Nitromint enhances the effect of the antiadrenergic drug Dihydroergotamine and reduces the effects of Heparin .
Analogs
Level 4 ATC code matches:
Nitrospray
Nitroglycerine
Efox
Monosan
Pectrol
Isoket
Erinite
Cardiket
Sustak Forte
Nitrosorbide
nitroglycerin preparations in tablets (regular and extended-release), in the form of spray, aerosol, ointment, transdermal patches and films for gluing to the gums: Nitroglycerin , Sustak , Sustonit , Nitrong , Nitroderm , Gluconit , Deponit 10 , Nitrocor , Nirmin , Nit-ret , Perlinganite , Trinitrolong, Nitradisk , Nitrospray-ICN , Nitrospray , Nitro , Nitrosprint .
Analogues and substitutes: what can you take instead?
Nitromint is a high-quality, fast-acting drug due to its release form in the form of a spray or aerosol. But sometimes it is not available in the pharmacy. If there is an urgent need to purchase some nitroglycerin, you can choose one of the Nitromint analogues:
Nitroglycerin - can be purchased in tablets or in aerosol form (Nitroglycerin-Aerosol);- Sustak – tablets with prolonged action (1 tablet – 6.4 mg of nitroglycerin);
- Nitrospray, Nitrospray-ICN, Nitrosprint - sublingual dosed sprays (1 injection dose - 0.4 mg of nitroglycerin);
- Nitro concentrate for intravenous infusion (in ampoules of 2 and 5 ml), prescribed only by a doctor in a hospital setting.
Reviews
Nitroglycerin in tablet form may not give the desired effect in a critical situation. When compared with sublingual tablets, the use of an aerosol is more effective - the onset of action is accelerated, the antianginal effect is more pronounced and the duration of an angina . In this connection, the drug in this release form is suitable for providing “first aid”. A number of patients prefer the aerosol form due to its ease of use.
There are negative reviews that are associated with the presence of adverse reactions. Nitromint spray, like all nitrates , causes a pulsating headache that lasts from 15 minutes to several hours in some patients. In elderly patients it is accompanied by dizziness. The occurrence of headache is noted after the first doses of the drug. It is more often observed when using long-acting drugs.
In order to reduce this side effect, it is recommended to use drugs with menthol (for example, Validol ) or NSAIDs ( Acetylsalicylic acid , Paracetamol ) together. Side effects such as heartburn , nausea and vomiting are much less common.
Nitromint price, where to buy
You can buy it in many pharmacies in Moscow and other cities.
The price of Nitromint spray 10 g (180 doses) ranges from 149 rubles. up to 170 rub.
- Online pharmacies in RussiaRussia
- Online pharmacies in UkraineUkraine
- Online pharmacies in KazakhstanKazakhstan
ZdravCity
- Nitromint spray sublingual.
dosage 0.4 mg/dose 180 doses cylinder 10g ZAO Pharmaceutical Plant EGIS RUB 134 order
Pharmacy Dialogue
- Nitromint (aerial 180 doses) Egis
RUB 149 order
- Nitromint (spray 180 doses) Egis
RUB 142 order
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Pharmacy24
- Nitromint 0.4 mg/dose 10 g aerosol ZAT FZ EGIS/VAT Pharmaceutical plant EGIS, Ugorshchina/Ugorshchina
99 UAH.order
PaniPharmacy
- Nitromint aerosol Nitromint aer. 1% 10g Hungary, Egis
132 UAH order
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Overdose of the drug Nitromint, symptoms and treatment
Symptoms: headache, severe arterial hypotension, tachycardia, dizziness, hot flashes, vomiting, diarrhea, methemoglobinemia. In case of excessive overdose, cyanosis, dyspnea and tachypnea and changes in blood counts (methemoglobinemia) may occur. Treatment: for collapse, intravenous infusion of 0.9% sodium chloride solution, norepinephrine and/or dopamine is indicated. For methemoglobinemia:
- intravenous administration of methylene blue (maximum 50 ml of 1% solution); ascorbic acid intravenously - 1 g in the form of a solution of sodium salt of ascorbic acid or in the form of tablets - 1 g orally;
- toluidine blue at an initial dose of 2–4 mg/kg body weight intravenously, then 2 mg/kg again;
- oxygen therapy, hemodialysis, blood transfusion, blood transfusion.
