This reduces cardiac work and myocardial oxygen demand. Expansion of coronary blood flow and improves coronary favored partitioning in reduced blood circulation, thereby increasing oxygen delivery to the myocardium. The decrease winstrol drops for sale venous return results in a reduction of filling pressure, improve blood supply to the subendocardial layers to reduce the pressure in the pulmonary circulation and the regression of symptoms of pulmonary edema. Nitroglycerin has a central inhibitory effect on sympathetic vascular tone, inhibiting the formation of the vascular component of pain. Nitroglycerin relaxes smooth muscle cells of the bronchi, urinary tract, gall bladder, bile ducts, esophagus, small intestine and colon. The action begins quickly, the effect develops within 1-1.5 minutes and lasts for about 30 minutes.
Bioavailability is 100% for sublingual as excluded “primary” hepatic degradation of the drug. The maximum plasma concentration is reached after 4 minutes. Communication to plasma proteins is 60%. Rapidly metabolized involving nitrate to form di- and mononitrate (only active isosorbide-5-mononitrate), the final metabolite – glycerol. Excreted by the kidneys as metabolites. Total clearance is 25-30 l / min. After receiving the drug under the tongue half-life from plasma is 2,5-4,4 minutes.Circulating nitroglycerin strongly associated with the erythrocytes and accumulates in the vessel walls. The primary route of elimination of nitroglycerin – extraction of metabolites in the urine ;, less than 1% of the dose is excreted unchanged.
- prevention of angina attacks by the use of prophylactic medication before exercise;
- relief of angina;
- acute left ventricular failure (including acute myocardial infarction).
- hypersensitivity to organic nitrates;
- form-closure glaucoma;
- severe hypotension;
- increased intracranial pressure caused by bleeding in the brain or trauma;
- concomitant use of phosphodiesterase inhibitors.
- age of 18 years (the lack of sufficient clinical data).
Precautions: acute myocardial infarction with low pressure filling of the left ventricle (the risk reduction in blood pressure and tachycardia, which may enhance ischaemia), chronic heart failure with low filling pressure of the left ventricle, severe anemia, triotoksikoz, hypertrophic cardiomyopathy (possibly more frequent angina attacks), heavy renal failure, hepatic failure (risk of meggemoglobinemii).
Pregnancy and lactation
There are winstrol for sale no data on the penetration of nitroglycerin into breast milk.
Use in pregnancy and during breastfeeding requires careful matching of risk and benefit, and should be under strict medical supervision.
DOSAGE AND ADMINISTRATION
The drug is recommended to take a doctor’s prescription in order to avoid complications.
Relief of angina attack
The first attack of angina, apply 1 or 2 doses under the tongue. If necessary, can be applied repeatedly with a 5-minute intervals. If, after receiving three doses within 15 minutes of an attack are not cropped, you should immediately consult a doctor.
From prevention to
1 dose applied for 5-10 minutes prior to the expected load or stress.
The highest single dose of 4 doses. The highest daily dose of 16 doses.
Terms of the drug:
- Sit on the possibilities
- remove the protective cap from the bottle, hold the bottle vertically
- open your mouth and hold your breath for a few seconds
- Click once on the balloon, sending a jet of medication under the tongue
- close your mouth and try to swallow the drug
At first use, or after a long period of non-use is recommended before the direct application of a single dose to reset the air to fill the spray chamber.
Side effect On the part of the cardiovascular system: dizziness, headache, tachycardia, fever, decreased blood pressure; rare (especially in overdose) – orthostatic collapse, cyanosis.
From the digestive system: dry mouth, rarely – nausea, vomiting, abdominal pain.
On the part of the central nervous system: weakness, rare – anxiety, psychotic reactions, lethargy, disorientation.
Allergic reactions: seldom – skin rash, itching.
Local reactions: skin redness, burning under the tongue
Other: rarely – blurred vision, hypothermia, methemoglobinemia.
Treatment: In mild cases – the patient’s transfer to a prone position with raised legs. In severe forms of overdose should apply general methods of treatment of intoxication and shock (volume replacement, norepinephrine and / or dopamine, etc.).
The use of epinephrine (adrenaline) is contraindicated.
The following antidotes and treatments can be used in the development of methemoglobinemia:
- Vitamin C – 1 g of sodium salt or intravenously.
- Methylene blue is intravenously at a dose of 50 ml of 1% solution.
- Toluidine blue intravenously, the first dose of 2.4 mg / kg, then multiply by 2 mg / kg.
- Oxygen therapy, hemodialysis, transfusion (exchange) of blood.
INTERACTION WITH OTHER DRUGS
Other vasodilators and antihypertensive winstroldepot for sale drugs (beta-blockers, blockers “slow” calcium channel blockers), angiotensin-converting enzyme (ACE) inhibitors, antipsychotics, tricyclic antidepressants, monoamine oxidase inhibitors (MAOIs), procainamide, and ethanol can enhance the hypotensive effect nitroglycerin. Dihydroergotamine nitroglycerin increases efficiency and reduces the effect of heparin.Against the background of quinidine and procainamide may cause orthostatic collapse.
Simultaneous treatment with inhibitors of phosphodiesterase type 5 (PDE 5) -sildenafil, tadalafil, vardenafil – can enhance the ability of the drug to reduce blood pressure.
Nitroglycerin enhances catecholamine excretion and vanilinmindalnoy acid in the urine.
Use of alcoholic beverages is strictly prohibited during use of the drug.
Effect on vehicle driving and work that requires attention
At the beginning of treatment should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions. In the future, the degree of limitation is determined individually for each patient.