Nitromak Retard injection is used to treat hypertension (high blood pressure) during surgery or to control congestive heart failure in patients who have had a heart attack. It may also be used to produce hypotension (low blood pressure) during surgery. Nitromak Retard injection is sometimes used to treat angina (chest pain) in patients who have been treated with other medicines that did not work well.
Nitromak Retard belongs to the group of medicines called nitrates. It works by relaxing the blood vessels and increasing the supply of blood and oxygen to the heart while reducing its work load.
Nitromak Retard is to be given only by or under the direct supervision of your doctor.
Nitromak Retard indications
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
Nitromak Retard Slocaps® (Nitromak Retard) are indicated for the prevention of angina pectoris due to coronary artery disease. The onset of action of oral Nitromak Retard is not sufficiently rapid for this product to be useful in aborting an acute anginal episode.
How should I use Nitromak Retard?
Use Nitromak Retard aerosol as directed by your doctor. Check the label on the medicine for exact dosing instructions.
An extra patient leaflet is available with Nitromak Retard aerosol. Talk to your pharmacist if you have questions about this information.
Do NOT shake Nitromak Retard aerosol.
Do NOT inhale the spray. Nitromak Retard aerosol is to be used on or under the tongue.
Before using the medicine for the first time, prime the pump by spraying 10 times into the air away from yourself and others. If you do not use Nitromak Retard aerosol within 6 weeks, reprime by spraying twice into the air.
To use Nitromak Retard aerosol, remove the plastic cover. Hold the container upright with your forefinger on top of the grooved button. Open your mouth and bring the container as close to your mouth as possible. Press the button firmly to release the spray onto or under your tongue. Release the button and close your mouth after each dose.
Replace the plastic cover after you are finished using Nitromak Retard aerosol.
Do not swallow right away after you use a dose. Do not spit or rinse your mouth for 5 to 10 minutes after you use Nitromak Retard aerosol.
To treat an angina attack, use 1 to 2 sprays on or under the tongue as directed by your doctor. Sit quietly after using a dose. A spray may be repeated approximately every 5 minutes as directed by your doctor. Do not use more than 3 sprays in 15 minutes unless your doctor tells you otherwise. If chest pain continues after a total of 3 sprays, seek medical attention at once, unless your doctor gives you different instructions.
If you use Nitromak Retard aerosol to prevent angina caused by physical activity, use it 5 to 10 minutes before activity unless your doctor tells you otherwise.
Check the level of fluid in your container regularly. While the container is in the upright position, if the fluid level reaches the top or middle of the hole on the side of the container, you should get a refill of Nitromak Retard aerosol.
If you miss a dose of Nitromak Retard aerosol and you are still having chest pain, contact your doctor right away. Ask your health care provider any questions you may have about the proper use of Nitromak Retard aerosol.
Ask your health care provider any questions you may have about how to use Nitromak Retard aerosol.
Uses of Nitromak Retard in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Nitromak Retard extended-release capsules are used to prevent chest pain (angina) in people with a certain heart condition (coronary artery disease). This medication belongs to a class of drugs known as nitrates. Angina occurs when the heart muscle is not getting enough blood. This drug works by relaxing and widening blood vessels so blood can flow more easily to the heart.
This medication will not relieve chest pain once it occurs. It is also not intended to be taken just before physical activities (such as exercise, sexual activity) to prevent chest pain. Other medications may be needed in these situations. Consult your doctor for more details.
How to use Nitromak Retard
Take this medication by mouth, usually 3 to 4 times daily or as directed by your doctor. It is important to take the drug at the same times each day. Do not change the dosing times unless directed by your doctor. The dosage is based on your medical condition and response to treatment.
Swallow this medication whole. Do not crush or chew the capsules. Doing so can release all of the drug at once and may increase your risk of side effects.
Use this medication regularly to get the most benefit from it. Do not suddenly stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased.
Although unlikely, when this medication is used for a long time, it may not work as well and may require different dosing. Tell your doctor if this medication stops working well (for example, you have worsening chest pain or it occurs more often).
Nitromak Retard description
Glyceryl trinitrate, also known as Nitromak Retard.
Nitromak Retard dosage
Nitromak Retard Dosage
Generic name: Nitromak Retard 20mg in 1g
Dosage form: ointment
Nitro-Dur transdermal patch
Nitrolingual oral spray
NitroMist sublingual aerosol
Nitrostat tablet, sublingual
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
As noted above (CLINICAL PHARMACOLOGY), controlled trials have demonstrated that Nitromak Retard ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. Doses used in clinical trials have ranged from 1/2 inch (1.3 cm; 7.5 mg) to 2 inches (5.1 cm; 30 mg), typically applied to 36 square inches (232 square centimeters) of truncal skin.
It is reasonable to believe that the rate and extent of Nitromak Retard absorption from ointment may vary with the site and square measure of the skin over which a given dose of ointment is spread, but these relationships have not been adequately studied.
Controlled trials with other formulations of Nitromak Retard have demonstrated that if plasma levels are maintained continuously, all anti-anginal efficacy is lost within 24 hours. This tolerance cannot be overcome by increasing the dose of Nitromak Retard. As a result, any regimen of Nitromak Retard® administration should include a daily nitrate-free interval. The minimum necessary length of such an interval has not been defined, but studies with other Nitromak Retard formulations have shown that 10 to 12 hours is sufficient.
Thus, one appropriate dosing schedule for Nitromak Retard® would begin with two daily 1/2- inch (7.5 mg) doses, one applied on rising in the morning and one applied six hours later. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. The foilpac is intended as a unit dose package only and is equivalent to approximately 1 inch as squeezed from the tube. Use entire contents of foilpac to obtain full dose and discard immediately after use.
Each tube of ointment and each box of foilpacs is supplied with a pad of ruled, impermeable, paper applicators. These applicators allow ointment to be absorbed through a much smaller area of skin than that used in any of the reported clinical trials, and the significance of this difference is not known. To apply the ointment using one of the applicators, place the applicator on a flat surface, printed side down. Squeeze the necessary amount of ointment from the tube onto the applicator, place the applicator (ointment side down) on the desired area of the skin, and tape the applicator into place.
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Phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil, vardenafil, and tadalafil have been shown to potentiate the hypotensive effects of organic nitrates.
The time course of the interaction appears to be related to the half-life of the PDE5 inhibitor, however, the dose dependence of this interaction has not been studied. Use of Nitromak Retard within a few days of PDE5 inhibitors is contraindicated.
Patients receiving antihypertensive drugs, beta-adrenergic blockers, and other nitrates should be observed for possible additive hypotensive effects when using Nitromak Retard. Marked orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used concomitantly.
Beta-blockers blunt the reflex tachycardia produced by Nitromak Retard without preventing its hypotensive effects. If beta-blockers are used with Nitromak Retard in patients with angina pectoris, additional hypotensive effects may occur.
Coadministration of aspirin (at doses between 500 mg and 1000 mg) and Nitromak Retard has been reported to result in increased Nitromak Retard maximum concentrations by as much as 67% and AUC by 73% when administered as a single dose. The pharmacological effects of Nitromak Retard may be enhanced by concomitant administration of aspirin.
Tissue-type Plasminogen Activator (t-PA)
Intravenous administration of Nitromak Retard decreases the thrombolytic effect of tissue-type plasminogen activator (t-PA). Plasma levels of t-PA are reduced when coadministered with Nitromak Retard. Therefore, caution should be observed in patients receiving Nitromak Retard during t-PA therapy.
Although an interaction has been reported between intravenous heparin and intravenous Nitromak Retard (resulting in a decrease in the anticoagulant effect of heparin), the data are not consistent. If patients are to receive intravenous heparin and Nitromak Retard concurrently, the anticoagulation status of the patient must be checked.
Oral administration of Nitromak Retard markedly decreases the first-pass metabolism of dihydroergotamine and consequently increases its oral bioavailability. Ergotamine is known to precipitate angina pectoris. Therefore the possibility of ergotism in patients receiving Nitromak Retard should be considered.
The vasodilating effects of Nitromak Retard have been shown to be additive to the effects observed with alcohol.
Adverse reactions to Nitromak Retard are generally dose related, and almost all of these reactions are the result of Nitromak Retard’s activity as a vasodilator. Headache, which may be severe, is the most commonly reported side effect. Headache may be recurrent with each daily dose, especially at higher doses. Transient episodes of lightheadedness, occasionally related to blood pressure changes, may also occur. Hypotension occurs infrequently, but in some patients it may be severe enough to warrant discontinuation of therapy. Syncope, crescendo angina, and rebound hypertension have been reported but are uncommon.
Allergic reactions to Nitromak Retard are also uncommon, and the great majority of those reported have been cases of contact dermatitis or fixed drug eruptions in patients receiving Nitromak Retard in ointments or patches. There have been a few reports of genuine anaphylactoid reactions, and these reactions can probably occur in patients receiving Nitromak Retard by any route.
Extremely rarely, ordinary doses of organic nitrates have caused methemoglobinemia in normal-seeming patients. Methemoglobinemia is so infrequent at these doses that further discussion of its diagnosis and treatment is deferred.
Application-site irritation may occur but is rarely severe.
In two placebo-controlled trials of intermittent therapy with Nitromak Retard patches at 0.2 to 0.8 mg/hr, the most frequent adverse reactions among 307 subjects were as follows:
Hypotension and/or syncope
To report SUSPECTED ADVERSE REACTIONS, contact Valeant Pharmaceuticals North America LLC at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Do not use Nitromak Retard Lingual Spray in patients who are taking PDE-5 inhibitors, such as avanafil, sildenafil, tadalafil, or vardenafil. Concomitant use can cause severe hypotension, syncope, or myocardial ischemia.
Do not use Nitromak Retard Lingual Spray in patients who are taking the soluble guanylate cyclase (sGC) stimulator riociguat. Concomitant use can cause hypotension.
4.2 Severe Anemia
Nitromak Retard Lingual Spray is contraindicated in patients with severe anemia (large doses of Nitromak Retard may cause oxidation of hemoglobin to methemoglobin and could exacerbate anemia).
4.3 Increased Intracranial Pressure
Nitromak Retard Lingual Spray may precipitate or aggravate increased intracranial pressure and thus should not be used in patients with possible increased intracranial pressure (e. g. cerebral hemorrhage or traumatic brain injury).
Nitromak Retard Lingual Spray is contraindicated in patients who are allergic to Nitromak Retard, other nitrates or nitrites or any excipient.
4.5 Circulatory Failure and Shock
Nitromak Retard Lingual Spray is contraindicated in patients with acute circulatory failure or shock.
DailyMed. "NITROGLYCERIN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
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