Nitro 400mcg Spray

✔️ Side Effects

Possible adverse effects include:

• Headache, dizziness, flushing, nausea, vomiting.
• Weakness, postural hypotension, reflex tachycardia.

✔️ Overdose Management

Symptoms: Severe hypotension, headache, flushing, nausea, syncope, methemoglobinemia, visual changes, seizures, or circulatory collapse.

Treatment:

Keep the patient in a recumbent position with elevated legs.

Administer oxygen and provide ventilatory support as needed.

For methemoglobinemia, administer methylene blue IV (1–2 mg/kg of 1% solution).

Gastric lavage may be helpful if ingestion was recent.

✔️ Dosage & Administration

• At the onset of angina: Administer 1 or 2 sprays under the tongue.
• Maximum dose: Do not exceed 3 sprays within 15 minutes.
• Prophylactic use: Administer 5–10 minutes before exertion or anticipated triggers.

If chest pain persists after administration, seek immediate medical help.

Pediatrics: Safety and efficacy not established.

Use cautiously in patients with renal/hepatic impairment, hypothyroidism, malnutrition, or hypothermia.

ঔষধটি রুটিন ব্যবহারের জন্য নয়, কেবলমাত্র বুকে ব্যথা শুরু হলে ব্যবহার করুন।

✔️ Usage Instructions

• Sit down as soon as symptoms appear.
• Remove the cap; do not shake the canister.
• Hold upright with your index finger on the spray button.
• Aim under the tongue and press the button slowly.
• Close the mouth and avoid swallowing or drinking water for 5–10 minutes.
• If needed, repeat the above steps after a short interval.
• Keep an extra supply accessible (e.g., on a bedside table) at all times.

✔️ Drug Interactions

• Alcohol may enhance hypotensive effects.
• May interact with dihydroergotamine, increasing bioavailability.
• Additive hypotension may occur with calcium channel blockers, phenothiazines, and tricyclic antidepressants.

✔️ Contraindicated in:

• Hypersensitivity to nitrates.
• Hypotension, hypovolemia, severe anemia.
• Cerebral hemorrhage, brain trauma.
• Mitral stenosis, HOCM-related angina.
• Concurrent use of phosphodiesterase inhibitors.

✔️ Precautions

• Avoid alcohol after administration.
• Do not use concurrently with sildenafil, vardenafil, or tadalafil due to the risk of severe hypotension, syncope, or fatal cardiovascular events.
• Not intended for continuous daily use.
• Keep out of reach of children.

✔️ Use in Pregnancy & Lactation

• Pregnancy Category C: Use only if necessary.
• Excretion in breast milk is unknown—exercise caution during lactation.

✔️ Storage

Store in a cool, dry place, protected from heat and light. Keep out of children's reach.