Nitromint
Nitromint: instructions for use and reviews
- 1. Release form and composition
- 2. Pharmacological properties
- 3. Indications for use
- 4. Contraindications
- 5. Method of application and dosage
- 6. Side effects
- 7. Overdose
- 8. Special instructions
- 9. Application during pregnancy and lactation
- 10. Use in childhood
- 11. In case of impaired renal function
- 12. For violations of liver function
- 13. Drug interactions
- 14. Analogs
- 15. Terms and conditions of storage
- 16. Terms of dispensing from pharmacies
- 17. Reviews
- 18. Price in pharmacies
Latin name: Nitromint
ATX code: C01DA02
Active ingredient: nitroglycerin (glyceryl trinitrate) (nitroglycerin)
Producer: EGIS Pharmaceuticals, PLC (Hungary)
Description and photo update: 2019-19-08
Prices in pharmacies: from 126 rubles.
Buy
Nitromint is a vasodilator drug used in the treatment of angina pectoris.
Release form and composition
Nitromint is produced in the form of a dosed sublingual aerosol: almost colorless or colorless, transparent, without sediment (in aluminum cylinders for 180 doses (10 g), 1 cylinder in a cardboard box complete with a spray head and a dosing pump).
The composition of 1 dose includes:
- Active substance: nitroglycerin - 0.4 mg (in the form of a 1% solution);
- Auxiliary components: propylene glycol, ethanol.
Pharmacological properties
Pharmacodynamics
Nitromint is a peripheral vasodilator that predominantly affects the venous vessels.
The venodilating effect of nitroglycerin is due to the ability to release nitric oxide from its molecule. Due to this, the enzyme guanylate cyclase is activated, which leads to an increase in the intracellular level of cGMP (cyclic guanosine monophosphate). As a result, the penetration of calcium ions into smooth muscle cells is prevented and their relaxation occurs.
The vasodilatation associated with relaxation of the smooth muscles of the vascular wall reduces venous return to the heart (preload) and the resistance of the systemic circulation (afterload). Thus, the work of the heart and myocardial oxygen demand are reduced.
With the expansion of the coronary vessels, there is an improvement in coronary blood flow and its redistribution in the area with reduced blood supply, as a result of which oxygen delivery to the myocardium increases.
Due to the decrease in venous return, the filling pressure decreases, the blood supply to the subendocardial layers improves, the pressure in the pulmonary circulation decreases, and the regression of symptoms in pulmonary edema.
Nitroglycerin, inhibiting the vascular component of the formation of pain syndrome, has a central inhibitory effect on the sympathetic vascular tone. Also, the substance helps to relax the smooth muscle cells of the esophagus, small and large parts of the intestine and their sphincters, bronchi, bile ducts, gall bladder, urinary tract.
The therapeutic effect of Nitromint develops quickly - in 1–1.5 minutes, its duration is about 30 minutes.
Pharmacokinetics
From the oral cavity, nitroglycerin is rapidly and fully absorbed into the systemic circulation. Bioavailability for sublingual use is 100%. This is due to the lack of metabolism during the first pass through the liver. C max (maximum concentration of the substance) in blood plasma is reached in 4 minutes.
The degree of binding to blood plasma proteins is 60%.
Circulating nitroglycerin strongly binds to erythrocytes, accumulation occurs in the walls of blood vessels.
With the participation of nitrate reductase, it is rapidly metabolized. As a result, mono- and dinitrates are formed (only isosorbide-5-mononitrate exhibits pharmacological activity), the final metabolite is glycerol.
After applying Nitromint under the tongue, T 1/2 (half-life) from blood plasma is in the range from 2.5 to 4.4 minutes. The total ground clearance is 25–30 l / min.
Excretion is carried out mainly in the form of metabolites in the urine, less than 1% is excreted unchanged.
Indications for use
- Angina pectoris (for the purpose of stopping and preventing seizures, including before exercise);
- Acute left ventricular failure (simultaneously with other drugs).
Contraindications
Absolute:
- Shock;
- Collapse;
- Age under 18;
- Hypersensitivity to drug components and other organic nitrates.
Relative (Nitromint is prescribed with caution in the presence of the following diseases / conditions):
- Orthostatic hypotension;
- Severe anemia and thyrotoxicosis;
- Intracranial hypertension;
- Acute circulatory failure, accompanied by severe arterial hypotension (systolic pressure less than 90 mm Hg);
- Hypertrophic cardiomyopathy;
- Hemorrhagic stroke;
- Migraine;
- Chronic heart failure and acute myocardial infarction with low left ventricular filling pressure;
- Traumatic brain injury;
- Severe hepatic and / or renal impairment;
- Epilepsy;
- Alcoholism;
- Angle-closure glaucoma.
For nursing and pregnant women, Nitromint can be used only after assessing the benefit / risk ratio for the health of the mother and the child.
Instructions for use of Nitromint: method and dosage
Aerosol Nitromint is applied sublingually.
Before the first use of the drug, the dosing pump must be filled by removing the protective cap and pressing the dosing valve several times (until the aerosol appears). After a long break in the use of Nitromint, there may be a need to refill the pump. During use, the container must be held vertically with the spray head up. Do not shake the can before use.
Each time the metering valve is pressed, 1 dose (0.4 mg of nitroglycerin) is released in the form of an aerosol from a cylinder equipped with a mechanical pump.
To stop an attack of angina pectoris, 0.4-0.8 mg (1-2 doses) of Nitromint is injected sublingually, preferably in a sitting position.
Hold your breath while applying the aerosol. The interval between single doses is about 30 seconds. After administration of the drug, you need to keep your mouth closed for a few seconds. If necessary, you can enter another 1 dose. You can take 3 doses for a maximum of 15 minutes.
5-10 minutes before the load in order to prevent the development of an attack of angina pectoris, 1 dose of Nitromint is used.
Patients with acute left ventricular failure, developing pulmonary edema, are sublingually applied 4 doses of the drug (1.6 mg) for a short period of time under strict hemodynamic control (systolic blood pressure should exceed 100 mm Hg). If necessary, after 10 minutes, the drug can be re-administered in the same dose.
Correction of the dosage regimen of Nitromint for elderly patients is not required.
Side effects
- Central Nervous System: weakness; rarely - disorientation, psychotic reactions, anxiety, lethargy;
- Digestive system: dry mouth; rarely - abdominal pain, vomiting, nausea;
- Cardiovascular system: lowering blood pressure, headache, dizziness, tachycardia, fever; rarely (mainly, especially in case of overdose) - orthostatic collapse, cyanosis;
- Allergic reactions: rarely - skin rash, itching;
- Local reactions: burning under the tongue, flushing of the skin;
- Others: rarely - blurred vision, methemoglobinemia, hypothermia.
Overdose
The main symptoms are: dizziness, headache, reflex tachycardia, decreased blood pressure, orthostatic hypotension, facial flushing, diarrhea and vomiting, increased drowsiness, asthenia, a feeling of heat. In the case of using excessively high doses (more than 20 mg / kg), symptoms manifest themselves in the form of methemoglobinemia, cyanosis, tachypnea and dyspnea, orthostatic collapse.
Therapy:
- mild course: the patient must be transferred to a horizontal position with raised legs;
- severe course: symptomatic / supportive treatment aimed at eliminating intoxication and shock (including replenishing the circulating blood volume, administration of norepinephrine / dopamine). Adrenaline (epinephrine) is contraindicated.
In cases of development of methemoglobinemia, the following antidotes and treatment methods can be used:
- ascorbic acid: 1000 mg, by mouth as sodium salt or intravenously;
- methylene blue (1% solution): up to 50 ml, intravenously;
- toluidine blue: first dose - from 2 to 4 mg / kg, then 2 mg / kg multiple times, intravenously;
- hemodialysis, oxygen therapy, exchange blood transfusion.
special instructions
Nitromint enhances urinary excretion of vanillin mandelic acid and catecholamines.
During therapy, alcohol should be excluded.
Influence on the ability to drive vehicles and complex mechanisms
At the beginning of the use of Nitromint, it is recommended to refrain from driving vehicles and performing potentially hazardous types of work that require an increased concentration of attention and quick psychomotor reactions. In the course of further treatment, the doctor determines the degree of restrictions individually.
Application during pregnancy and lactation
According to the instructions, Nitromint during pregnancy / lactation can be used only after assessing the ratio of the expected benefit to the possible risk.
There is no data confirming / refuting the excretion of nitroglycerin in breast milk.
Pediatric use
Therapy with Nitromint is contraindicated in patients under 18 years of age.
With impaired renal function
Nitromint for severe renal failure is prescribed under medical supervision.
For violations of liver function
Aerosol Nitromint for severe liver failure is prescribed under medical supervision.
Drug interactions
Patients who have previously received organic nitrates (isosorbide dinitrate or isosorbide mononitrate) may require higher doses of nitroglycerin.
With the simultaneous use of Nitromint with some drugs, the following effects may occur:
- PDE5 inhibitors specific to cyclic guanosine monophosphate (PDE5) and used in the treatment of erectile dysfunction (for example, vardenafil, sildenafil, tadalafil): increased antihypertensive effect of Nitromint (simultaneous use is contraindicated);
- Angiotensin-converting enzyme inhibitors, procainamide, other vasodilators and antihypertensive drugs (slow calcium channel blockers, beta-blockers), tricyclic antidepressants, antipsychotics, monoamine oxidase inhibitors: increased hypotensive effect of nitroglycerin;
- Dihydroergotamine: an increase in its concentration in the blood serum and an increase in its vasoconstrictor effect, which can reduce the effect of Nitromint. The combination of these drugs in patients with diseases of the coronary vessels requires special care, which is associated with the likelihood of narrowing of the coronary vessels and the development of ischemia;
- Heparin: reducing its anticoagulant effect;
- Sapropterin (nitric oxide synthetase coenzyme): increased risk of arterial hypotension;
- Norepinephrine (norepinephrine): a decrease in its therapeutic effect;
- Barbiturates: accelerating metabolism and reducing the concentration of nitro compounds in blood plasma;
- Amiodarone, propranolol, slow calcium channel blockers (nifedipine, verapamil): increased antianginal effect;
- Beta-adrenomimetics, alpha-blockers (dihydroergotamine): a decrease in the severity of the antianginal effect (excessive decrease in blood pressure, tachycardia).
Analogs
Nitromint analogs are: Nitroglycerin, Sustak, Sustonit, Nitrong, Nitroderm, Gluconit, Deponit 10, Nitrocor, Nirmin, Nit-ret, Perlinganit, Trinitrolong, Nitradisk, Nitrosprey-ICN, Nitrosprey, Nitro, Nitro.
Terms and conditions of storage
Store away from heat sources, protected from light, out of reach of children, at a temperature of 15-25 ° C.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Available without a prescription.
Reviews about Nitromint
According to reviews, Nitromint is used as an emergency aid to relieve angina attacks. In most cases, the drug has a quick therapeutic effect, but many users note the development of adverse reactions, manifested mainly in the form of headaches. The cost of the spray is estimated to be affordable.
Price for Nitromint in pharmacies
The approximate price for Nitromint (1 can of 10 g) is 130-148 rubles.
Nitromint: prices in online pharmacies
|
Drug name Price Pharmacy |
|
Nitromint 0.4 mg / dose spray sublingual dosed 10 g 1 pc. 126 RUB Buy |
|
Nitromint spray sublingual. dosage. 0.4mg / dose 180 doses bottle 10g 136 RUB Buy |
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!
