Nitroglycerin relaxes the vascular smooth muscle. Although the precise details remain unclear, the direct effect on vascular smooth muscle appears to be the result of liberation of free radicals of nitric oxide (NO) which activates guanylate cyclase, resulting in increased synthesis of cyclic GMP. It is possible that nitric oxide (NO) combines with sulfhydryl groups in the endothelium and produces S-nitrosothiols that stimulate guanylate cyclase production. This is enhanced by N-acetylcysteine which provides a source of sulfhydryl groups. Cyclic GMP reduces stored calcium and thus interferes with calcium-activated smooth muscle contraction.
Nitrocard Spray: Each metered dose contains Diluted Nitroglycerin USP equivalent to Nitroglycerin 0.40 mg.
Nitrocard Spray is indicated for acute angina & for the prophylaxis.
During an anginal attack, one or two sprays should be administered under tongue. The medication should not be expectorated or the mouth rinsed for 5 to 10 minutes following administration. A spray may be repeated approximately every 3-5 minutes as needed. No more than three metered sprays are recommended within a 15-minute period. If chest pain persists, prompt medical attention is recommended. Nitrocard spray may be used 5 to 10 minutes prior to engaging in activities which might provoke an acute attack.
Hypersensitivity to nitrates, obstructive hypertrophic cardiomyopathy, low cardiac output secondary to hypovolemia, inferior myocardial infarction with right ventricular involvement, mitral valve prolapsed etc.
The drug should be used with caution in patients who may have volume depletion from diuretic therapy or in patients who have low systolic blood pressure (e.g., below 90 mm Hg). Paradoxical bradycardia and increased angina pectoris may accompany nitroglycerin-induced hypotension. Amplification of the vasodilatory effects of this spray by certain drugs (phosphodiesterase inhibitors) used to treat erectile dysfunction can result in severe hypotension.
Adverse reactions to oral nitroglycerin may include headache, flushing, dizziness, nausea, vomiting, weakness, restlessness, postural hypotension etc.
Orthostatic hypotension may occur with the combined use of calcium channel blockers, phenothiazine and tricyclic antidepressants. Use of alcohol with nitroglycerin may produce severe hypotension and collapse.
Use in Pregnancy:
There are no adequate and well-controlled studies in pregnant women. Nitroglycerin should be given to pregnant women only if clearly needed.
Use in nursing mothers:
It is not known whether nitroglycerin is excreted in human milk. Because many drugs
are excreted in human milk, caution should be exercised when Nitrocard Spray is administered to a nursing woman.
Pediatric Use:
Safety and effectiveness of nitroglycerin in pediatric patients have not been established.
Nitrocard Spray: Each canister contains 200 metered doses.
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