Angised Tab 30s

Side Effects of Angised Tab 30s

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.

Drug 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.

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.

Mechanism of Action

Glyceryl trinitrate acts on the enzyme nitric oxide stimulating guanylate cyclase in the vascular smooth muscle cells resulting in the relaxation of smooth muscles. It reduces venous return (preload) and facilitates subendocardial blood flow with redistribution into ischaemic areas. It relieves coronary vasospasm and dilates arterioles reducing afterload. It is useful for relief and prevention of anginal attacks. Onset: 1-3 minutes (sublingual, buccal); 30-60 minutes (transdermal, topical); 1-2 minutes (IV). Duration: 30-60 minutes (sublingual); 3-5 hr (buccal, as modified-release preparations); 24 hr (transdermal); 8 hr (topical, as ointment); 3-5 minutes (IV). Absorption: Rapidly absorbed from oral mucosa (sublingual), well absorbed from the GI tract (oral), well absorbed from the skin (topical, transdermal). Distribution: Widely distributed: Smooth muscles of the blood vessels. Metabolism: Extensive hepatic 1st pass metabolism by glutathione-organic nitrate reductase (yielding dinitrates and mononitrates); also undergoes hydrolysis in the plasma. Excretion: Urine (as inactive metabolites).

Special Precautions

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.

How to Use

Take orally with food and water, as directed by your physician.

How to Store

Keep in a cool, dry place away from sunlight and moisture.

Safety Concerns

• Alcohol: Avoid during treatment.
• Breastfeeding: Not recommended.
• Pregnancy: Contraindicated.
• Liver/Kidney: Use with caution.

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