Severe and prolonged pain of ischemic origin in the heart area associated with myocardial infarction or unstable angina. Heart failure and pulmonary edema associated with acute myocardial infarction. Hypertension associated with open heart surgery and other surgeries. Providing controlled arterial hypotension during surgery.
active substance: nitroglycerin;
1 ml of solution contains glyceryl trinitrate solution of 5% in ethanol in terms of 100% content of the main substance – 10.0 mg;
excipient: ethanol (96%).
Clear colorless or light yellow liquid.
Nitroglicerin is an antianginal drug of the group of peripheral vasodilators with a predominant effect on venous vessels. The mechanism of action is associated with the release of the active substance nitric oxide (NO) in vascular smooth muscle. Nitric oxide causes the activation of guanylate cyclase and increases the level of cGMP, which leads to the relaxation of smooth muscle cells in the walls of blood vessels. Under the influence of nitroglycerin, arterioles and precapillary sphincters relax to a lesser extent than large arteries and veins.
The antianginal effect of nitroglycerin is mainly due to a decrease in myocardial oxygen demand due to a decrease in preload (dilation of veins and reduction of blood flow to the right atrium) and postload (reduction of total peripheral vascular resistance). Promotes the distribution of coronary circulation in ischemic areas of the myocardium. Increases exercise tolerance in patients with coronary heart disease, angina. In heart failure, it helps to unload the myocardium, mainly by reducing preload. Reduces pressure in the small circle of blood circulation.
- Severe and prolonged pain of ischemic origin in the heart area associated with myocardial infarction or unstable angina.
- Heart failure and pulmonary edema associated with acute myocardial infarction.
- Hypertension associated with open heart surgery and other surgeries.
- Providing controlled arterial hypotension during surgery.
Hypersensitivity to nitroglycerin and other nitro compounds. Hypovolemia, severe arterial hypotension (systolic pressure <90 mm Hg), acute myocardial infarction localized in the right ventricle, increased intracranial pressure (due to head injury or cerebral hemorrhage), cardiac tamponade, hypertrophic obstructive constipation cardiomyopathy glaucoma, toxic pulmonary edema, anemia, acute vascular insufficiency (shock, vascular collapse).
Experience in children is limited.
Use during pregnancy or breastfeeding
Information on the use of the drug during pregnancy is limited, so it is not recommended for use by pregnant women. Adverse reactions observed in an infant fed by a woman being treated with the drug are unlikely and mild.
Breastfeeding should be discontinued during treatment. If it is necessary to use the drug for vital signs, the benefit / risk ratio should be weighed.
Method of application and dosage
Nitroglicerin dosing regimen is set individually, depending on the clinical response and systolic blood pressure.
An infusion solution containing 100 μg / ml nitroglycerin is usually used. This solution is prepared by diluting 1 ampoule of Nitroglycerin, concentrate for infusion of 10 mg / ml (= 20 mg of nitroglycerin) in 200 ml of 0.9% sodium chloride solution, 5% glucose solution or isotonic glucose-saline solution to obtain a solution concentration of 100 μg / Jr. You can use higher concentrations, but not more than 400 μg / ml.
Infusion systems should be made of polyethylene (PE), polypropylene (PP), polytetrafluoroethylene (PTFE) or glass. Nitroglycerin is absorbed by materials made of polyvinyl chloride (PVC) and polyurethane (PU), which requires increasing its dose.
Symptoms: hypotension, tachycardia, fever, redness, headache, palpitations, syncope. Increased intracranial pressure, which can lead to confusion and neurological disorders. Overdose for several hours can lead to ethanol intoxication.
Treatment. Excessive hypotension can be eliminated by reducing the infusion rate of the drug or stopping its administration. In severe hypotension, the patient should be placed in a horizontal position with the head edge of the bed lowered. In arterial hypotension associated with bradycardia, the use of atropine and dopamine is indicated. Hypoxia caused by methemoglobinemia can cause cyanosis, metabolic acidosis, coma, convulsions, vascular collapse. In methemoglobinemia, a solution of methylene blue (1-2 mg / kg body weight) is administered intravenously.
- From the psyche: a feeling of anxiety.
- From the nervous system: headache; dizziness; syncope.
- From the eyes: visual impairment.
- From the cardiovascular system: tachycardia, hypotension (especially orthostatic); tides; bradycardia, cyanosis.
- From the digestive tract: nausea, vomiting.
- On the skin: urticaria.
- General disorders: respiratory disorders, weakness.
Store Nitroglicerin at a temperature of 8 ° C to 15 ° C in the original package, away from fire.
Keep out of reach of children.