Nitromak Retard Overdose

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What happens if I overdose Nitromak Retard?

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Nitromak Retard ointment:

Store Nitromak Retard ointment at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep the tube tightly closed. Use within 8 weeks of first opening. Keep Nitromak Retard ointment out of the reach of children and away from pets.

Overdose of Nitromak Retard in details

When a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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Hemodynamic Effects:

Nitromak Retard toxicity is generally mild. The estimated adult oral lethal dose of Nitromak Retard is 200 mg to 1,200 mg. Infants may be more susceptible to toxicity from Nitromak Retard. Consultation with a poison center should be considered.

Laboratory determinations of serum levels of Nitromak Retard and its metabolites are not widely available, and such determinations have, in any event, no established role in the management of Nitromak Retard overdose.

No data are available to suggest physiological maneuvers (e.g., maneuvers to change the pH of the urine) that might accelerate elimination of Nitromak Retard and its active metabolites. Similarly, it is not known which – if any – of these substances can usefully be removed from the body by hemodialysis.

No specific antagonist to the vasodilator effects of Nitromak Retard is known, and no intervention has been subject to controlled study as a therapy of Nitromak Retard overdose. Because the hypotension associated with Nitromak Retard overdose is the result of venodilatation and arterial hypovolemia, prudent therapy in this situation should be directed toward increase in central fluid volume. Passive elevation of the patient’s legs may be sufficient, but intravenous infusion of normal saline or similar fluid may also be necessary.

The use of epinephrine or other arterial vasoconstrictors in this setting is likely to do more harm than good.

In patients with renal disease or congestive heart failure, therapy resulting in central volume expansion is not without hazard. Treatment of Nitromak Retard overdose in these patients may be subtle and difficult, and invasive monitoring may be required.

Methemoglobinemia:

Nitrate ions liberated during metabolism of Nitromak Retard can oxidize hemoglobin into methemoglobin. Even in patients totally without cytochrome b5 reductase activity, however, and even assuming that nitrate moieties of Nitromak Retard are quantitatively applied to oxidation of hemoglobin, about 1 mg/kg of Nitromak Retard should be required before any of these patients manifests clinically significant (≥10%) methemoglobinemia. In patients with normal reductase function, significant production of methemoglobin should require even larger doses of Nitromak Retard. In one study in which 36 patients received 2 to 4 weeks of continuous Nitromak Retard therapy at 3.1 to 4.4 mg/hr, the average methemoglobin level measured was 0.2%; this was comparable to that observed in parallel patients who received placebo.

Notwithstanding these observations, there are case reports of significant methemoglobinemia in association with moderate overdoses of organic nitrates. None of the affected patients had been thought to be unusually susceptible.

Methemoglobin levels are available from most clinical laboratories. The diagnosis should be suspected in patients who exhibit signs of impaired oxygen delivery despite adequate cardiac output and adequate arterial PO2. Classically, methemoglobinemic blood is described as chocolate brown, without color change on exposure to air.

Methemoglobinemia should be treated with methylene blue if the patient develops cardiac or CNS effects of hypoxia. The initial dose is 1 to 2 mg/kg infused intravenously over 5 minutes. Repeat methemoglobin levels should be obtained 30 minutes later and a repeat dose of 0.5 to 1.0 mg/kg may be used if the level remains elevated and the patient is still symptomatic. Relative contraindications for methylene blue include known NADH methemoglobin reductase deficiency or G-6-PD deficiency. Infants under the age of 4 months may not respond to methylene blue due to immature NADH methemoglobin reductase. Exchange transfusion has been used successfully in critically ill patients when methemoglobinemia is refractory to treatment.

What should I avoid while taking Nitromak Retard?

Avoid using Nitromak Retard topical on irritated or broken skin.

Nitromak Retard can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid drinking alcohol. It can increase some of the side effects of Nitromak Retard topical.

Nitromak Retard warnings

Warnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.
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Amplification of the vasodilatory effects of Nitromak Retard by sildenafil can result in severe hypotension. The time course and dose dependence of this interaction have not been studied. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with volume expansion.

Nitromak Retard readily migrates into many plastics, including the polyvinyl chloride (PVC) plastics commonly used for intravenous administration sets. Nitromak Retard absorption by PVC tubing is increased when the tubing is long, the flow rates are low, and the Nitromak Retard concentration of the solution is high. The delivered fraction of the solution's original Nitromak Retard content has been 20-60% in published studies using PVC tubing; the fraction varies with time during a single infusion, and no simple correction factor can be used. PVC tubing has been used in most published studies of intravenous Nitromak Retard, but the reported doses have been calculated by simply multiplying the flow rate of the solution by the solution's original concentration of Nitromak Retard. The actual doses delivered have been less, sometimes much less, than those reported.

Some in-line intravenous filters also absorb Nitromak Retard; these filters should be avoided.

Because of the problem of Nitromak Retard absorption by polyvinyl chloride (PVC) tubing, Nitromak Retard Injection should be used with the least absorptive infusion tubing (i.e., non-PVC tubing) available.

DOSING INSTRUCTIONS MUST BE FOLLOWED WITH CARE. WHEN THE APPROPRIATE INFUSION SETS ARE USED, THE CALCULATED DOSE WILL BE DELIVERED TO THE PATIENT, BECAUSE THE LOSS OF Nitromak Retard Injection SEEN WITH STANDARD PVC TUBING WILL BE AVOIDED. THE DOSAGES REPORTED IN PUBLISHED STUDIES UTILIZED GENERAL-USE PVC ADMINISTRATION SETS, AND RECOMMENDED DOSES BASED ON THIS EXPERIENCE WILL BE TOO HIGH WHEN THE LOW-ABSORBING INFUSION SETS ARE USED.

What should I discuss with my healthcare provider before taking Nitromak Retard?

Some medical conditions may interact with Nitromak Retard tablets. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

Some MEDICINES MAY INTERACT with Nitromak Retard tablets. Tell your health care provider if you are taking any other medicines, especially any of the following:

This may not be a complete list of all interactions that may occur. Ask your health care provider if Nitromak Retard tablets may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

Nitromak Retard precautions

Certain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
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General

Only the smallest dose required for effective relief of the acute anginal attack should be used. Excessive use may lead to the development of tolerance. Nitromak Retard USP tablets are intended for sublingual or buccal administration and should not be swallowed. Severe hypotension, particularly with upright posture, may occur even with small doses of Nitromak Retard. The drug should be used cautiously in patients with volume depletion or low systolic blood pressure.

Paradoxical bradycardia and increased angina pectoris may accompany Nitromak Retard-induced hypotension.

Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy.

Tolerance to the vascular and antianginal effects of Nitromak Retard and cross-tolerance to other nitrates and nitrites may occur.

The drug should be discontinued if blurring of vision or drying of the mouth occurs. Excessive dosage of Nitromak Retard may produce severe headaches.

Information for patients

If possible, patients should sit down when taking Nitromak Retard tablets USP. This eliminates the possibility of falling due to lightheadedness or dizziness.

Nitromak Retard may produce a burning or tingling sensation when administered sublingually; however, the ability to produce a burning or tingling sensation should not be considered a reliable method for determining the potency of the tablets.

Nitromak Retard should be kept in the original glass container, tightly capped. The cotton should be discarded once the bottle is opened.

Administration of Nitromak Retard tablets USP is contraindicated in patients who are using Viagra® (sildenafil citrate). Viagra® has been shown to potentiate the hypotensive effects of organic nitrates.

Interactions

Drug interactions

Concomitant use of nitrates and alcohol may cause hypotension. Patients receiving antihypertensive drugs, beta-adrenergic blockers or phenothiazines and nitrates should be observed for possible additive hypotensive effects. Marked orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used concomitantly. Dose adjustment of either class of agent may be necessary.

Aspirin may decrease the clearance and enhance the hemodynamic effects of sublingual Nitromak Retard. A decrease in the therapeutic effect of sublingual Nitromak Retard may result from use of long-acting nitrates.

Drug/laboratory test interactions

Nitrates may interfere with the Ziatkis-Zak color reaction causing a false report of decreased serum cholesterol.

Carcinogenesis, mutagenesis, impairment of fertility

No long-term studies in animals were performed to evaluate the carcinogenic potential of Nitromak Retard.

Pregnancy

Pregnancy Category C

Animal reproduction studies have not been conducted with Nitromak Retard. It is also not known whether Nitromak Retard can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Nitromak Retard should be given to apregnant woman only if clearly needed.

Nursing mothers

It is not known whether Nitromak Retard is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when intravenous Nitromak Retard is administered to a nursing woman.

Pediatric use

The safety and effectiveness of Nitromak Retard in pediatric patients have not been established.

What happens if I miss a dose of Nitromak Retard?

When you miss a dose, you should take it as soon as you remember, but you should take care that it should be well spaced from the next dose. You should not take an extra dose at the time of the second dose as it will become a double dose. The double dose can give unwanted side effects, so be careful. In chronic conditions or when you have a serious health issue, if you miss a dose, you should inform your health care provider and ask his suggestion.

Since Nitromak Retard is taken as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 2 hours away. Do not take extra medicine to make up the missed dose.



References

  1. 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).
  2. DrugBank. "nitroglycerin". http://www.drugbank.ca/drugs/DB00727 (accessed September 17, 2018).
  3. MeSH. "Explosive Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).

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