Nitrocard 400mcg Spray

✔️ Side Effects:

Common: Headache, flushing, dizziness, postural hypotension, tachycardia, nausea, vomiting, dry mouth, localized burning.

Serious: Syncope, methemoglobinemia, paradoxical bradycardia, visual changes, exfoliative dermatitis, prolonged bleeding time.

Potentially Fatal: Severe hypotension, respiratory depression, cardiovascular collapse.

✔️ Dosage & Administration

• Acute Angina Relief: Administer 1–2 sprays under or onto the tongue at the onset of pain. Repeat every 3–5 minutes if needed, but do not exceed 3 sprays within 15 minutes. Seek emergency care if symptoms persist.
• Prophylaxis: Use 1–2 sprays 5–10 minutes prior to exertion or known angina triggers.

Renal Dosing

CrCl 10–50 mL/min: Extend dosing interval to every 24–72 hours.

CrCl <10 mL/min: Dose every 72–96 hours with close monitoring.

Special Instructions:

• Sit down when using the spray to reduce the risk of fainting.
• Do not inhale, rinse, or swallow immediately after use.
• Do not drink water for at least 5–10 minutes post-administration.
• Keep the spray accessible at all times and store away from heat or direct sunlight.
• Avoid alcohol and PDE5 inhibitors (e.g., sildenafil, tadalafil) due to the risk of severe hypotension or cardiac events.

✔️ Overdose Management

Symptoms include: Profound hypotension, headache, nausea, cyanosis, methemoglobinemia, arrhythmias, and collapse.
Treatment: Keep patient supine and warm. Supportive measures include oxygen, IV fluids, and methylene blue (for methemoglobinemia). Gastric lavage may help if ingestion was recent.

✔️ Drug Interactions

• May increase the effects of dihydroergotamine and prolong neuromuscular blockade from pancuronium.
• Reduced efficacy when used with drugs causing dry mouth (e.g., anticholinergics).
• NSAIDs (including aspirin) may blunt its anti-anginal effects.
• Risk of dangerous hypotension when used with alcohol, calcium channel blockers, tricyclic antidepressants, and other vasodilators.

✔️ Contraindications

Contraindicated in patients with hypersensitivity to nitrates, severe hypotension, hypovolemia, significant anemia, cerebral hemorrhage, recent head trauma, hypertrophic cardiomyopathy, or concurrent use of PDE5 inhibitors.

✔️ Precautions

Use cautiously in:

• Hepatic/renal impairment
• Hypothyroidism
• Malnutrition
• Hypothermia
• Cerebrovascular disease or glaucoma
• Patients with mitral valve prolapse, cardiac tamponade, or cor pulmonale

Pregnancy (Category C): Use only if clearly indicated

Lactation: Unknown if excreted in breast milk—use with caution

Prolonged high-dose use may lead to tolerance; ensure a nitrate-free interval in chronic use.

✔️ Storage

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