Nitric oxide enhances the intracellular concentration of cyclic guanozinmonofosfatazy that prevents the penetration of calcium ions into smooth muscle cells, causing their relaxation.Relaxation of smooth muscles of the vascular wall causes vasodilation, which reduces venous return to the heart (preload) and the resistance of the systemic circulation (afterload). This winstrol side effects reduces cardiac work and myocardial oxygen demand. Expansion coronary improve coronary blood flow and promotes its redistribution in reduced blood circulation, thereby increasing oxygen delivery to the myocardium.
The decrease in venous return results in a reduction of the filling pressure, improving blood supply subendocardial layers to reduce the pressure in the pulmonary circulation and 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 of the bronchi and cells of the urinary tract, gallbladder, bile ducts, esophagus, small intestine and colon, as well as their sphincters. Action begins quickly, the effect develops within 1-1.5 minutes and lasts for about 30 minutes.
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.
Angina (mild and prevention of attacks, including before exercise).
Hypersensitivity to nitrates; collapse, shock; age of 18 years (the lack of sufficient clinical data). With care : acute circulatory failure accompanied by severe arterial hypotension (systolic blood pressure below 90 mm Hg), orthostatic hypotension, hemorrhagic stroke, acute myocardial infarction and chronic heart failure with winstrol side effects low pressure left ventricular filling, hypertrophic cardiomyopathy, severe renal and / or hepatic failure, severe anemia and thyrotoxicosis, alcoholism, epilepsy, brain injury, intracranial hypertension, angle-closure glaucoma (risk of increased intraocular pressure), migraine.
Pregnancy and lactation
Extraction of Nitroglycerin into breast milk has not been established.
The use of Nitrokora® during pregnancy and while breast-feeding requires careful matching of risk and benefit, and should be under strict medical supervision.
Dosing and Administration
The drug is recommended to use a doctor intended to prevent complications.
At the first signs of an attack of angina pectoris, depending on the severity, type follows: 1 dose (containing 0.4 mg of nitroglycerin) obtained by clicking on the dosing pump is applied on or under language against the backdrop of breath-holding. If necessary for the relief of angina is used again at 5-minute intervals.
If, after receiving three metered doses within 15 minutes of relief did not come, it is necessary to consult a doctor.
For prophylaxis administered 1 dose of 5 – 10 minutes before the expected load or stress.
Before use of packaging is not shaken, keep spray vertically, straight ahead. After each spraying mouth shut, did not immediately swallow. The highest single dose of 4 doses. The highest daily dose:. 16 doses
On first use, or after long periods of non-use is recommended before the direct application of a single dose to reset the air to fill the spray chamber.
Cardio-vascular 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: . rare – skin rash, itching, Local reactions: skin redness, burning under the tongue Other: rarely – blurred vision, hypothermia, methemoglobinemia.
Symptoms: headache, decreased blood pressure, orthostatic hypotension, reflex tachycardia, dizziness, facial flushing, vomiting and diarrhea, fatigue, excessive sleepiness, feeling the heat. Extremely high doses (over 20 mg / kg) lead to methemoglobinemia, cyanosis, dyspnea and tachypnea, ortovtaticheskomu collapse. Treatment: In mild cases – the patient’s transfer to a prone position with raised legs. In severe occurrences of overdose should apply general methods of treatment of intoxication and shock (volume replacement, norepinephrine and / or dopamine, etc.). The use of epinephrine 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 drugs (beta-blockers, blockers “slow” calcium channel blockers), angiotensin-converting enzyme (ACE) inhibitors, antipsychotics, tricyclic antidepressants, inhibitors monoamiooksidazy (MAO) inhibitors, phosphodiesterase, procainamide, sildenafil (Viagra) and ethanol can strengthen hypotensive Nitrokora® effect.
Nitrokor® dihydroergotamine enhances the effect and reduces the effectiveness of heparin.
Drinking alcohol while using the drug is strictly prohibited.
The effect on driving vehicles and work that requires attention
at the beginning of treatment should refrain from driving motor vehicles and activities potentially winstrol side effects hazardous activities that require high concentration and psychomotor speed reactions. In the future, the degree of limitation is determined individually for each patient.
Metered spray for sublingual administration according to 8g aluminum cylinders or vials of amber glass or polypropylene containing 10 ml of a 1% solution of nitroglycerin, equipped with metering pumps, nozzles and protective caps. The container (vial) with instructions for use are placed in a pile of cardboard. lixus labs