Family doctor

TYPE/ BRAND:

Glyceryl trinitrate:

• Anginine
• Nitrobid
• Nitrolingual Pumpspray
• Nitradisc
• Nitrocor
• Nitraderm
• Nitro-Dur

Isosorbide dinitrate:

• Carvasin
• Coronex

Isosorbide mononitrate:

• Ismo 20
• Corangin
• Imtrate
• Imdur

USE: Vasodilators: angina

Nitrates are potent vasodilators which have a useful role in the management and treatment of angina. Angina results form an inadequate supply of oxygen carrying blood to the heart muscle via the coronary arteries.

These medicines work by dilating veins (reduce pre-load) and arteries (reduce after-load) and reducing the overall workload of the heart. The overall effect is the relief of episodes of chest pain (angina).

They can be taken on an as needed basis as a dose during or just before anticipated exercise to reduce angina.

They may also be used long term as a regular medication to reduce episodes of angina.

Cautions:

• Do not use sildenafil (Viagra) if you are using these medications.
• Hypersensitivity to nitrates
• Liver and kidney impairment
• Hypotensive conditions
• Cerebral haemorrhage and head trauma
• Hypothyroidism
• Malnutrition

Side effects:

Occasional: flushing, headache, nausea and dizziness (postual hypotension), tachycardia, nitrate tolerance (discuss with doctor).

Overdose: marked flushing of the face, severe headache, hypotension and fainting.

Interactions:

Enhanced hypotensive effect with sildenafil (Viagra) - avoid use.

Anticoagulants, antiarrthymias, antidepressants and antimuscarinincs reduce effect of nitrates.

Patient information:

• Follow the instructions carefully on the label of this medicine
• Alcohol: avoid due to enhanced vasodilation effect (dizziness, faintness)
• Sublingual pumpspray is used (1-2 doses. max 3 sprays per attack) when required under tongue to relieve chest pain (store in cool, dry place)
• Transdermal patch should be reapplied daily to a new skin site and be taken off for approx. 8 hours (usually overnight) to prevent nitrate tolerance
• Tablets are taken as directed (do not stop taking unless otherwise)
• Contact your doctor or seek urgent medical help if side effects are severe or ongoing (esp. headache).