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Nitromint

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Indications:

Oral: Management of stable angina, Sublingual: Acute angina, Intravenous: Unstable angina, Heart failure, Acute myocardial infarction, Induction of hypotension or control of hypertension during surgery, Transdermal: Management of stable angina, Prophylaxis of phlebitis and extravasation secondary to venous cannulation, Rectal: Pain due to chronic anal fissure, Topical/Cutaneous: Management of stable angina, Buccal: Acute angina, Heart failure.

Contraindications:

Hypersensitivity. Severe hypotension, heart failure, marked anaemia, hypertrophic obstructive cardiomyopathy, cerebral haemorrhage or head trauma, low cardiac output secondary to hypovolaemia, inferior MI with right ventricular involvement, raised intracranial pressure. Concomitant use with phosphodiesterase type-5 inhibitors.

Adverse reactions:

Facial flushing, dizziness, tachycardia, throbbing headache and tolerance. Large doses can cause vomiting, restlessness, hypotension, syncope, rarely cyanosis and methaemoglobinaemia, impaired respiration, bradycardia. IV admin: IV preparation contains substantial quantities of alcohol and alcohol intoxication can occur. Sublingual Tabs/Spray: Dry mouth, localised burning sensation. Topical: Contact dermatitis, erythema, local irritation. Transdermal patches: Contact dermatitis, metal-containing patches should be removed before cardioversion, defibrillation, diathermy. Buccal tablets: Delayed dissolution, may be swallowed by mistake. Potentially Fatal: Hypotension, paradoxical bradycardia, impaired respiration, syncope and collapse.

Interactions:

Enhances bioavailability of dihydroergotamine. Glyceryl trinitrate infusion may prolong pancuronium-induced neuromuscular blockade. May reduce the efficacy of heparin, alteplase and noradrenaline when used together. Efficacy of buccal and sublingual preparations may be reduced by drugs that can cause dry mouth due to decreased dissolution. Aspirin and other NSAIDs may reduce the therapeutic response to glyceryl trinitrate. Potentially Fatal: Orthostatic hypotension may be produced by combined use of calcium channel blockers, antihypertensives, phenothiazines and TCAs. Alcohol may cause severe hypotension and collapse.

Warnings:

Severe hepatic or renal impairment, hypothyroidism, malnutrition, hypothermia. Cerebrovascular disease, lung disease or cor pulmonale. Pregnancy, lactation, glaucoma, mitral valve prolapse, cardiac tamponade, syncope. Gradual withdrawal in patients who have received prolonged high dose infusions. Avoid prolonged excessive hypotension. Nitrate-free interval is recommended in patients on continuous treatment with nitrates to reduce risk of tolerance.

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