The action of nitroglycerin is due mainly to a decrease in myocardial oxygen demand by reducing preload (expansion of peripheral veins and reducing blood flow to the right atrium) and afterload (decrease total peripheral vascular resistance). It promotes npp steroid redistribution of coronary blood flow to ischemic areas of the myocardium. It increases exercise tolerance in patients with coronary heart disease and angina. It reduces pressure in the pulmonary circulation. Biosoluble polymer films have good adhesive properties, instantly adhere to the oral mucosa. Due to the presence of a hydrophilic matrix solid fat (cocoa butter) having hydrophobic properties to the film swollen with saliva, the conditions for the controlled release of nitroglycerin. Film trinitrolonga able to stop an attack of angina 1-1.5 minutes. Depending on the individual characteristics of the dissolution of the polymer film and the applied dose and duration of the anti-anginal effects antishemicheskogo averages 3-5 hours. It is important that the drug intermittently throughout the day avoids nitrate tolerance.
Also, the effect remains stable until near the end of the film resorption. 3-month course trinitrolonga has a more pronounced and stable antianginal and anti-ischemic effect. Thus the development of tolerance to it is observed. Dose picked individually, depending on the desired time of the film resorption in individual patients: 1 mg film – with resorption for 1-1.5 hours with 2 mg – 2-3 hours.
After 2 minutes after sticking the film on the gum concentration in the blood of an average 0.9 ± 0.5 mg / ml, 10 min – 0,9 ± 15 mg / ml, remaining at this level for 3 hours.
Indications for use
Applied for the prevention and relief of angina attacks.
: Hypersensitivity to nitrates, shock, collapse, severe hypotension. Concomitant use of inhibitors of phosphodiesterase 5 (such as sildenafil, varnenafil or tadalafil), since they potentiate the hypotensive nitrates action, up to age 18 years (effectiveness and safety have not been established), the presence of inflammatory changes in the patient’s oral mucosa, especially the upper gums (gingivitis, aphthous stomatitis).
Precautions (comparing the risks and benefits):
Pulmonary edema. Traumatic brain hypertension, cardiac npp steroid tamponade, uncontrolled hyper-volaemia, in patients with heart failure with normal or low pressure in the pulmonary artery, arterial hypotension . Closure type of glaucoma with high intraocular pressure, severe anemia, hypothyroidism, acute myocardial infarction with low pressure filling of the left ventricle, toxic pulmonary edema, subarachnoid hemorrhage, recently transferred skull trauma, hemorrhagic stroke, state, accompanied by the filling of the left ventricle pressure reduction (isolated mitral stenosis, constrictive pericarditis), idiopathic hypertrophic subaortic stenosis, stroke, severe renal and / or hepatic insufficiency (risk of methemoglobinemia). Gently npp steroid appoint hypertrophic cardiomyopathy due to the risk of paradoxical reactions.
Pregnancy and lactation
Application Trinitrolong during pregnancy and breastfeeding is possible only when the intended benefits to the mother outweighs the potential risk to the fetus and child.
Dosing and Administration
Trinitrolong recommended to take a doctor’s prescription. Initially dose Trinitrolong selects the physician (a film containing 1 mg or 2 mg). Subsequently, the patient takes the drug themselves. For this film adhered to the oral mucosa, generally in the upper gum. For this purpose, immediately after the occurrence of pain to the finger pressed film gums within a few seconds and left to dissolve. If necessary, increase the income of nitroglycerin in the blood should be 2-3 times to lick the language of film, without moving from the spot. If the pain quickly goes the rest of the film has not had time to disappear it is recommended to remove. In the absence of anti-anginal action, within the first 5 minutes is recommended to stick to the gums another film. In the absence of therapeutic effect after gluing two films should immediately consult a doctor.
On the part of the central nervous system: blurred vision, “nitrate” headache (especially at the beginning of treatment, long-term therapy decreases), dizziness, and a feeling of weakness, anxiety, psychotic reactions, lethargy, disorientation.
Cardio-vascular system: decrease in blood pressure, tachycardia, rarely (especially in overdose) orthostatic collapse, cyanosis, redness of the skin. From the gastrointestinal tract: dry mouth, nausea, vomiting, abdominal pain. In place of the film sticking may occur feeling of coolness and light npp steroid tingling. Allergic reactions, hypothermia.