The dose of a drug and dosage of the drug are two different terminologies. Dose is defined as the quantity or amount of medicine given by the doctor or taken by the patient at a given period. Dosage is the regimen prescribed by the doctor about how many days and how many times per day the drug is to be taken in specified dose by the patient. The dose is expressed in mg for tablets or gm, micro gm sometimes, ml for syrups or drops for kids syrups. The dose is not fixed for a drug for all conditions, and it changes according to the condition or a disease. It also changes on the age of the patient.
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NOT FOR DIRECT INTRAVENOUS INJECTION
Nitromak Retard Injection IS A CONCENTRATED, POTENT DRUG WHICH MUST BE DILUTED IN DEXTROSE (5%) INJECTION OR SODIUM CHLORIDE (0.9%) INJECTION PRIOR TO ITS INFUSION. Nitromak Retard Injection SHOULD NOT BE MIXED WITH OTHER DRUGS.
Initial Dilution:
Aseptically transfer the contents of one Nitromak Retard vial (50 mg of Nitromak Retard) into a 500 mL glass bottle of either Dextrose (5%) Injection or Sodium Chloride Injection (0.9%). This yields a final concentration of 100 mcg/mL. Diluting 5 mg Nitromak Retard into 100 mL will yield a final concentration of 50 mcg/mL.
Maintenance Dilution:
It is important to consider the fluid requirements of the patient as well as the expected duration of infusion in selecting the appropriate dilution of Nitromak Retard Injection.
After the initial dosage titration, the concentration of the solution may be increased, if necessary, to limit fluids given to the patient. The Nitromak Retard concentration should not exceed 400 mcg/mL. See chart.
Note: If the concentration is adjusted, it is imperative to flush or replace the infusion set before a new concentration is utilized. If the set were not flushed or replaced, it could take minutes to hours, depending upon the flow rate and the dead space of the set, for the new concentration to reach the patient.
Invert the glass parenteral bottle several times to assure uniform dilution of the Nitromak Retard.
Dosage is affected by the type of container and administration set used. See.
Although the usual starting adult dose range reported in clinical studies was 25 mcg/min or more, these studies used PVC administration sets. THE USE OF NON-ABSORBING TUBING WILL RESULT IN THE NEED FOR REDUCED DOSES.
If a peristaltic action infusion pump is used, an appropriate administration set should be selected with a drip chamber that delivers approximately 60 microdrops/mL. Table 1 and the Nitromak Retard Injection Dilution Table below may be used to calculate the Nitromak Retard dilution and flow rate in microdrops/minute to achieve the desired Nitromak Retard Injection administration rate.
If a volumetric infusion pump is used, an appropriate volumetric infusion pump connector set should be selected. Table 1 below may still be used; however, flow rate will be determined directly by the infusion pump, independent of the drop size of the appropriate set drip chambers. Thus, the reference to ``microdrops/min′′ is not applicable, and the corresponding flow rate in mL/hr should be used to determine pump settings.
When using a non-absorbing infusion set, the initial dosage should be 5 mcg/min delivered through an infusion pump capable of exact and constant delivery of the drug. Subsequent titration must be adjusted to the clinical situation, with dose increments becoming more cautious as partial response is seen. Initial titration should be in 5 mcg/min increments, with increases every 3-5 minutes until some response is noted. If no response is seen at 20 mcg/min, increments of 10 and later 20 mcg/min can be used. Once a partial blood pressure response is observed, the dose increase should be reduced and the interval between increases should be lengthened.
Some patients with normal or low left ventricular filling pressures or pulmonary capillary wedge pressure (e.g., angina patients without other complications) may be hypersensitive to the effects of Nitromak Retard and may respond fully to doses as small as 5 mcg/min. These patients require especially careful titration and monitoring.
There is no fixed optimum dose of Nitromak Retard. Due to variations in the responsiveness of individual patients to the drug, each patient must be titrated to the desired level of hemodynamic function. Therefore, continuous monitoring of physiologic parameters (i.e., blood pressure and heart rate in all patients, other measurements such as pulmonary capillary wedge pressure, as appropriate) MUST be performed to achieve the correct dose. Adequate systemic blood pressure and coronary perfusion pressure must be maintained.
Dilution:
Nitromak Retard Injection is supplied in 5 mg/mL solution. A dilution and administration scheme for Nitromak Retard Injection is shown in Table 1 below.
NOTE:
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
What other drugs will affect Nitromak Retard?
Many drugs can interact with Nitromak Retard. Below is just a partial list. Tell your doctor if you are using:
alteplase (Activase);
aspirin or heparin;
dihydroergotamine (D.H.E. 45, Migranal) or ergotamine (Ergomar, Cafergot, and others);
heart or blood pressure medication such as atenolol (Tenormin, Tenoretic), carvedilol (Coreg), labetalol (Normodyne, Trandate), metoprolol (Dutoprol, Lopressor, Toprol), nadolol (Corgard), nebivolol (Bystolic), propranolol (Inderal, InnoPran), sotalol (Betapace), and others; or
Nitromak Retard used in a pill form or spray under the tongue, or as a skin patch or skin ointment.
This list is not complete and there are many other drugs that can interact with Nitromak Retard. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.
Nitromak Retard interactions
Interactions are the effects that happen when the drug is taken along with the food or when taken with other medications. Suppose if you are taking a drug Nitromak Retard, it may have interactions with specific foods and specific medications. It will not interact with all foods and medications. The interactions vary from drug to drug. You need to be aware of interactions of the medicine you take. Most medications may interact with alcohol, tobacco, so be cautious.
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PDE5 inhibitors
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.
Antihypertensives
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.
Aspirin
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.
Heparin
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.
Ergotamine
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.
Alcohol
The vasodilating effects of Nitromak Retard have been shown to be additive to the effects observed with alcohol.
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References
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).
FDA/SPL Indexing Data. "G59M7S0WS3: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
The results of a survey conducted on ndrugs.com for Nitromak Retard are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Nitromak Retard. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.
User reports
Consumer reported frequency of use
No survey data has been collected yet
5 consumers reported doses
What doses of Nitromak Retard drug you have used? The drug can be in various doses. Most anti-diabetic, anti-hypertensive drugs, pain killers, or antibiotics are in different low and high doses and prescribed by the doctors depending on the severity and demand of the condition suffered by the patient. In our reports, ndrugs.com website users used these doses of Nitromak Retard drug in following percentages. Very few drugs come in a fixed dose or a single dose. Common conditions, like fever, have almost the same doses, e.g., [acetaminophen, 500mg] of drug used by the patient, even though it is available in various doses.
Users
%
1-5mg
5
100.0%
Consumer reviews
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