Microsoft word - anril sr.doc
Tablet: Each Sustained Release tablet contains Nitroglycerin USP 2.6
The principal pharmacological action of nitroglycerin is relaxation of vascular
smooth muscle, and consequent dilatation of peripheral arteries and veins,
especially the latter. Dilatation of the veins promotes peripheral pooling of blood
and decreases venous return to the heart, thereby reducing left ventricular end-
diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar
relaxation reduces systemic vascular resistance, systolic arterial pressure, and
mean arterial pressure (afterload). Dilatation of the coronary arteries also occurs.
The relative importance of preload reduction, afterload reduction, and coronary
dilatation remains undefined. Dosing regimens for most chronically used drugs
are designed to provide plasma concentrations that are continuously greater
than a minimally effective concentration. This strategy is inappropriate for
organic nitrates. Several well controlled clinical trials have used exercise testing
to assess the antianginal efficacy of continuously-delivered nitrates. In the large
majority of these trials, active agents were indistinguishable from placebo after
24 hours (or less) of continuous therapy. Attempts to overcome nitrate tolerance
by dose escalation, even to doses far in excess of those used acutely, have
consistently failed. Only after nitrates had been absent from the body for several
hours was their antianginal efficacy restored. INDICATION
The prophylaxis of chronic stable angina pectoris.
DOSAGE AND ADMINISTRATION
Adults and Elderly Patients: Dosage should be adjusted to the requirements of
the individual patient but will usually be 1 or 2 tablets taken three times daily.
The lowest effective dose should be used.
CONTRAINDICATIONS AND PRECAUTION
Nitroglycerin should not be used in patients with marked anaemia, head trauma,
cerebral haemorrhage, closed angle glaucoma, known hypersensitivity to
nitrates, hypotensive conditions, hypovolaemia, hypertrophic obstructive
cardiomyopathy, aortic/mitral stenosis, cardiac tempenade, constrictive
pericarditis, orthostatic dysfunction. Sildenafil has been shown to potentiate the
hypotensive effects of nitrates, and its co-administration with nitrates or nitric
oxide donors is therefore contraindicated.
Side-effects include facial flushing, headache, dizziness and postural hypotension
which may be associated with reflex tachycardia or paradoxical bradycardia.
Toxic effects of Nitroglycerin include vomiting, restlessness, cyanosis,
methaemoglobinaemia and syncope.
In the event of accidental or deliberate overdosage toxic effects of Nitroglycerin
include vomiting, restlessness, hypotension, cyanosis, methaemoglobinaemia,
tachycardia and syncope. Patients should receive gastric aspiration and lavage
and be given respiratory and circulatory support.
Nitroglycerin may enhance the effects of peripheral vasodilators. The
hypotensive effects of nitrates are potentiated by concurrent administration of
USE IN PREGNANCY AND LACTATION
There is no evidence relating to the safety of nitrates in pregnancy and lactation.
Nitrates should not be administered to pregnant women and nursing mothers
unless considered essential by the physician.
Store in a cool and dry place. Protect from light and moisture.
Tablet: Box containing 3x10 Sustained Release tablets in Alu-Alu
® Registered Trade Mark
The meeting was opened by President Bev at 10.05 a.m. who welcomed those present with a special welcome to our guests Jill and Roger Lockwood, Peter and Joy Molloy and Carol Lovegrove. A minutes silence was held in memory of our respected member the late Ed Thompson who recently passed away. Bev mentioned that she had a most enjoyable holiday and thanked Vice President Wilf for stepping in in h
MICHELANGELO: OASIS 5 (UA/NSTEMI) An international randomized double-blind studyevaluating the efficacy and safety of fondaparinux versus enoxaparinin the acute treatment of unstable angina / non ST-segment elevation MI 124 Canada Canadian Cardiovascular Collaboration (CCC) Project OfficePopulation Health Research InstituteHGH - McMaster Clinic, 237 Barton Street EastHamilton,