Trocer 400mcg Spray

✔️ Trocer sublingual spray is used for:

• Acute relief of an angina attack.
• Prophylaxis of angina pectoris due to coronary artery disease.

✔️ Side Effects

Common: Headache, facial flushing, dizziness, nausea, vomiting, weakness, postural hypotension, reflex tachycardia.

✔️ Pharmacology:

• Primary Action: Relaxes vascular smooth muscles.
• Effects:
  • Veins: Promotes blood pooling, decreases venous return to the heart, and reduces preload.
  • Arteries: Reduces systemic vascular resistance and arterial pressure, lowering afterload.
• Outcome: Relieves the workload on the heart and improves oxygen delivery.

✔️ Dosage & Administration:

At Onset of Angina:

• Administer 1 or 2 sprays under the tongue.
• Maximum: 3 sprays within 15 minutes.
• If chest pain persists, seek immediate medical attention.

Prophylactic Use:

• Spray 5-10 minutes before engaging in activities that may trigger an attack.

✔️ Special Instructions for Use:

1. Sit down as soon as angina symptoms begin.
2. Remove the plastic cap without shaking the container.
3. Hold the container upright with the forefinger on the button.
4. Open the mouth and aim the nozzle under the tongue.
5. Press the button slowly to spray.
6. Avoid swallowing immediately after spraying. Do not drink water for 5-10 minutes.

✔️ Interactions:

• Alcohol: This may cause severe hypotension and collapse.
• Medications:
  • May enhance dihydroergotamine bioavailability.
  • Risk of orthostatic hypotension with calcium channel blockers, phenothiazines, and tricyclic antidepressants.
  • Avoid concurrent use with sildenafil, vardenafil, or tadalafil due to the risk of severe hypotension, heart attack, or death.

✔️ Overdose Effects:

• Symptoms: Severe hypotension, headache, vertigo, visual disturbance, flushing, nausea, vomiting, cyanosis (methemoglobinemia), syncope, confusion, convulsions, and potentially fatal circulatory collapse.
• Treatment:
  • Keep the patient in a shock position and warm.
  • Administer oxygen and ventilatory support as needed.
  • Methemoglobinemia: Treat with intravenous methylene blue (1-2 mg/kg).
  • If ingested, gastric lavage may be useful.

✔️ Contraindications:

• Hypersensitivity to nitrates or formulation components.
• Conditions including:
  • Severe hypotension, hypovolemia, or anemia.
  • Cerebral hemorrhage or brain trauma.
  • Mitral stenosis or hypertrophic obstructive cardiomyopathy.

✔️ Pregnancy & Lactation:

• Pregnancy: Category C. Use only if needed.
• Lactation: Unknown if excreted in breast milk; use with caution.

✔️ Precautions & Warnings:

• Monitor hemodynamics and clinical status during early days of acute myocardial infarction.
• Use cautiously in patients with:
  • Impaired renal or hepatic function.
  • Hypothyroidism, malnutrition, or hypothermia.
• Pediatrics: Safety and efficacy not established.

✔️ Storage Conditions:

• Store in a cool, dry place away from light and heat.
• Keep out of the reach of children.