Pactorin 2.6 Tablet

✔️ Uses

Pactorin (Nitroglycerin) provides rapid relief and prevention of angina attacks by dilating the coronary and systemic vessels.

Pediatric: Safety and efficacy not established.

✔️ Mechanism of Action:

• Relaxes vascular smooth muscle.
• Dilates both arteries and veins (predominantly veins).
• Venodilation → decreases venous return → lowers left ventricular preload.
• Arterial dilation → reduces systemic vascular resistance (afterload).

Molecular Mechanism:

Nitroglycerin releases nitric oxide (NO) → activates guanylate cyclase → increases cGMP → causes smooth muscle relaxation and vasodilation.

Pharmacokinetics:

• Absorption: Rapid, making it effective for emergencies.
• Distribution: Volume of distribution ~3 L/kg.
• Metabolism: Rapid hepatic metabolism to di- and mononitrates.
• Excretion: Primarily renal, as di-nitro metabolites.

✔️ Dosage & Administration

Sublingual Tablet (0.5 mg):

Place under the tongue at the first sign of angina.

May repeat every 5 minutes if needed.

Max: 3 tablets within 15 minutes. If pain persists → seek urgent medical help.

Sustained-Release Tablet:

2.6 mg: 1 tablet twice daily (before meals). May increase to 2–3 tablets twice daily if needed.

6.4 mg: 1 tablet twice daily.

Dose is individualized as per patient response.

✔️ Drug Interactions

• Risk of additive hypotension with:
• Antihypertensives, β-blockers, phenothiazines.
• Alcohol.
• Aspirin (may potentiate vasodilatory effects).

✔️ Contraindications

• Concomitant use of PDE5 inhibitors (sildenafil, vardenafil, tadalafil).
• Severe anemia.
• Raised intracranial pressure.
• Hypersensitivity to nitrates/nitrites.
• Acute circulatory failure or shock.

✔️ Side Effects

Common: Headache, flushing, hypotension.

Overuse may lead to tolerance.

✔️ Pregnancy & Lactation

Safety not established.

Should only be used if benefits outweigh risks.

Unknown if excreted in breast milk.

✔️ Precautions & Warnings

Use the lowest effective dose for acute angina.

Caution in patients with hypotension or volume depletion.

Avoid excessive/continuous use due to tolerance risk.

✔️ Storage:

Store below 25°C, in a dry place, protected from light.

Keep out of reach of children.