Trinitrolong
Trinitrolong: 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. Use in the elderly
- 14. Drug interactions
- 15. Analogs
- 16. Terms and conditions of storage
- 17. Terms of dispensing from pharmacies
- 18. Reviews
- 19. Price in pharmacies
Latin name: Trinitrolong
ATX code: C01DA02
Active ingredient: nitroglycerin [Glyceryl trinitrate (nitroglycerin)]
Producer: Yaroslavl Pharmaceutical Factory, JSC (Russia), Progress RCC, JSC (Russia)
Description and photo update: 2019-08-07
Trinitrolong is a vasodilating agent, an antianginal drug.
Release form and composition
The drug is produced in the form of polymer films for sticking to the gums, packed in test tubes or cell packs (depending on the manufacturer): cell contour packs contain 10 films with a dosage of 1 mg (oval, from yellowish-white to light yellow) or 2 mg (oval, green), in a cardboard box 1 or 3 packages; glass test tubes contain 10, 20 or 40 films with a dosage of 2 mg (oval, green, length - 9 mm, width - 4.5 mm, thickness - 0.6 mm), 1 test tube in a cardboard box. Each pack also contains instructions for the use of Trinitrolong.
Composition of 1 film:
- active substance: nitroglycerin - 1 or 2 mg;
- auxiliary components: in films with a dosage of 1 mg - bio-soluble polymer, cocoa butter; in films with a dosage of 2 mg - bio-soluble polymer, cocoa butter, brilliant green.
Pharmacological properties
Pharmacodynamics
The active substance of Trinitrolong - nitroglycerin - is a peripheral vasodilator, which has a predominant effect on the venous vessels. Its mechanism of action is mainly associated with the ability to expand peripheral veins, reduce blood flow to the right atrium and total peripheral vascular resistance (OPSR), which leads to a decrease in myocardial oxygen demand and, as a consequence, a decrease in pre- and afterload.
Nitroglycerin redistributes coronary blood flow in the ischemic areas of the myocardium. Reduces pressure in the pulmonary circulation. Increases exercise tolerance in patients with ischemic heart disease.
Trinitrolong polymer biosoluble films have good adhesive properties, due to which they instantly adhere to the gums. They contain solid fat (cocoa butter), which has hydrophobic properties, due to which, after swelling from saliva, optimal conditions are created in the film for the controlled release of nitroglycerin. The polymer film is able to stop an angina attack in 1-1.5 minutes. The duration of antianginal and anti-ischemic effects is on average 3-5 hours, depending on the dose of Trinitrolong used and the individual characteristics of film dissolution.
An important advantage of the drug is intermittent intake throughout the day, which avoids the development of resistance to nitrates. In addition, the effect remains stable almost until the end of the resorption of the polymer film.
The course of treatment lasting 3 months has a more stable and pronounced antianginal and anti-ischemic effect. At the same time, the development of tolerance to the drug is not observed.
The optimal dose of Trinitrolong is selected depending on the individual time required for the film to dissolve: if it is 1–1.5 hours, a dose of 1 mg is recommended, if it is 2-3 hours, a dose of 2 mg.
Pharmacokinetics
2 minutes after gluing the polymer film to the gums, the concentration of nitroglycerin in the blood reaches 0.9 ± 0.5 mg / ml, after 10 minutes - 0.9 ± 15 mg / ml, at this level it remains for 3 hours.
Indications for use
Trinitrolong is indicated for the relief and prevention of angina attacks.
Contraindications
Absolute:
- severe arterial hypotension [systolic blood pressure (BP) <100 mm Hg. Art., diastolic blood pressure 60 mm Hg. Art.];
- collapse;
- shock;
- inflammatory changes in the oral mucosa, especially the upper gums (for example, gingivitis or aphthous stomatitis);
- age up to 18 years;
- concomitant use of phosphodiesterase 5 inhibitors (for example, sildenafil, vardenafil or tadalafil);
- hypersensitivity to drug components or other nitrates.
Relative (Trinitrolong should be used with caution after evaluating the benefits and risks):
- arterial hypotension (systolic blood pressure <90 mm Hg);
- heart failure with normal or low pulmonary artery pressure;
- acute myocardial infarction with low left ventricular filling pressure;
- idiopathic hypertrophic subaortic stenosis;
- conditions accompanied by a decrease in the filling pressure of the left ventricle (constrictive pericarditis, isolated mitral stenosis);
- cardiac tamponade;
- hypertrophic cardiomyopathy;
- hemorrhagic stroke;
- cranial hypertension;
- recent trauma to the skull;
- violation of cerebral circulation;
- subarachnoid hemorrhage;
- angle-closure glaucoma with high intraocular pressure;
- pulmonary edema (including toxic);
- uncontrolled hypervolemia;
- hypothyroidism;
- severe anemia;
- severe renal and / or hepatic impairment;
- pregnancy and lactation (provided that the benefits exceed the risks).
Trinitrolong, instructions for use: method and dosage
The doctor selects an adequate dose of Trinitrolong individually, it can be 1 or 2 mg. It is recommended to use the drug immediately after the onset of pain.
Films Trinitrolong must be glued to the mucous membrane of the oral cavity, optimally - in the upper gum area: press your finger to the gum for a few seconds and leave until dissolved. If it is necessary to increase the flow of nitroglycerin into the blood, you can lick the film with your tongue 2-3 times without moving it. If the pain passes quickly, it is recommended to remove the remainder of the film that did not have time to dissolve.
If there is no effect within 5 minutes after sticking the film, you should stick another one. If in this case the therapeutic effect does not develop, it is necessary to urgently call a doctor.
Side effects
- on the part of the cardiovascular system: lowering blood pressure, tachycardia; rarely (especially in case of overdose) - facial skin redness, cyanosis, orthostatic collapse;
- from the central nervous system: nitrate headache (especially at the beginning of Trinitrolong administration, decreases with continued treatment), blurred vision, feeling of weakness, dizziness, lethargy, anxiety, disorientation, psychotic reactions;
- from the digestive system: dry mouth, abdominal pain, nausea, vomiting;
- others: a feeling of chill and slight tingling at the place of sticking the film, hypothermia, allergic reactions.
Overdose
In case of an overdose of Trinitrolong, the following symptoms are possible: lowering blood pressure (below 90 mm Hg) with orthostatic dysregulation, palpitations, severe weakness, headache, severe dizziness, fainting, fever, drowsiness, asthenia, convulsions, shortness of breath. In severe cases, dyspnoea, tachypnea, methemoglobinemia, cyanosis, collapse are noted.
The patient should immediately take a horizontal position and urgently call a doctor.
special instructions
Patients who have previously taken organic nitrates may require a higher dose of Trinitrolong to obtain the desired hemodynamic effect.
During the period of therapy, an excessive decrease in blood pressure and the appearance of dizziness may occur when suddenly getting up from a sitting or lying position, as well as in hot weather, performing physical exercises, drinking alcohol.
The drug can increase angina pectoris with a sharp decrease in blood pressure, cause ischemia, up to the development of myocardial infarction and sudden death (paradoxical nitrate reactions).
Trinitrolong can interfere with visual clarity and cause dry mouth. If these symptoms are severe or persist for a long time, the drug should be discontinued.
In case of headache, it is recommended to reduce the dose of Trinitrolong or the simultaneous use of validol.
During the period of therapy, caution should be exercised in patients with hypertrophic cardiomyopathy, since there is a risk of developing paradoxical reactions.
If the film swells after gluing but does not dissolve, it is likely that it has expired.
With frequent use of organic nitrates, including Trinitrolong, the formation of addiction is possible, which does not require an increase in the dose.
Influence on the ability to drive vehicles and complex mechanisms
Against the background of therapy, it is possible to reduce the clarity of visual perception, the speed of motor and mental reactions. This should be taken into account by persons engaged in activities requiring increased attention and vehicle drivers.
Application during pregnancy and lactation
According to the indications, Trinitrolong during pregnancy / lactation may be prescribed by a doctor if the expected benefits of treatment outweigh the potential risks to the fetus / child.
Pediatric use
Trinitrolong is not intended for the treatment of children and adolescents under the age of 18.
With impaired renal function
According to the indications, Trinitrolong should be used with caution in patients with severe renal insufficiency, given the possible risk of developing methemoglobinemia.
For violations of liver function
Trinitrolong should be used with caution in severe hepatic impairment, given the possible risk of methemoglobinemia.
Use in the elderly
There are no special instructions on the dosage regimen for the elderly.
Drug interactions
Nitroglycerin, when used simultaneously, reduces the effectiveness of heparin. After its cancellation, a significant decrease in blood clotting is possible, as a result of which a decrease in the dose of heparin is required.
Novocainamide and quinidine may contribute to the development of orthostatic collapse.
Excessive development of the hypotensive effect of nitroglycerin is possible in the case of uncontrolled concomitant use of the following drugs: antihypertensive drugs, slow calcium channel blockers, vasodilators, diuretics, beta-blockers, phosphodiesterase inhibitors, monoamine oxidase (MAO) inhibitors, tricyclic antidepressants, ethanol.
Nitroglycerin can increase the concentration of dihydroergotamine in the blood and increase its bioavailability, which is fraught with an increase in blood pressure.
Analogs
Trinitrolong analogs are: Dilasid, Dinisorb, Izacardin, Izoket, Isosorbide Mononitrate, Cardiket, Monizol, Mono Mac, Monolong, Monosan, Monochinque, Nitroglycerin, Nitrocor, Nitrolong, Nitromint, Sidrosorbid and dr.
Terms and conditions of storage
Store at temperatures below 25 ° С out of reach of children, protected from light, dry place, away from fire.
The shelf life is 3 years.
Terms of dispensing from pharmacies
Dispensed by prescription.
Reviews about Trinitrolong
Reviews about Trinitrolong are positive: the drug effectively and quickly relieves angina attacks, so many call it "first aid" for the heart.
Among the shortcomings, they point to the development of side effects such as headache and dizziness, as well as a large list of contraindications.
The cost of Trinitrolong is estimated to be affordable.
Price for Trinitrolong in pharmacies
The approximate price for Trinitrolong for a pack of 10 films of 2 mg is 55 rubles.
Maria Kulkes Medical journalist About the author
Education: First Moscow State Medical University named after I. M. Sechenov, 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!
