Therapeutic uses of Nitromint

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1. Uses of Nitromint

What is Nitromint? Nitromint 2.6mg contains the active ingredient nitroglycerin 2.6mg. Nitroglycerin acts on the smooth muscle components of blood vessel walls, causing peripheral veins to dilate. As a result, venous capacity increases while venous return, left ventricular volume, end-diastolic pressure, and preload all decrease. Additionally, with the dilation of small arteries, peripheral resistance decreases, and afterload is reduced. This leads to less strain on the heart and lower oxygen demand.

Nitroglycerin also dilates subepicardial coronary arteries, reducing coronary artery spasm. Due to these effects and the reduction in preload, blood flow to the heart becomes more even, collateral circulation and perfusion to ischemic areas, and subepicardial regions improve. Consequently, the heart's efficiency and exercise tolerance both increase.

Nitromint is indicated in the following cases:

•    Long-term treatment of coronary artery disease and prevention of angina pectoris;
•    Supportive treatment of congestive heart failure (in combination with digitalis, ACE inhibitors, diuretics, or vasodilators).

Nitromint is contraindicated in the following cases:

•    Individuals hypersensitive to nitroglycerin or other organic nitrates;
•    Patients with low blood pressure (systolic pressure below 90 mmHg);
•    Individuals with acute circulatory failure (shock, collapse);
•    Patients with cardiogenic shock (unless end-diastolic pressure in the left ventricle is adequately maintained by an intra-aortic balloon pump or positive inotropic drugs);
•    Patients with acute myocardial infarction with low ejection pressure;
•    Individuals with hypertrophic obstructive cardiomyopathy.
•    Patients with hypovolemia;
•    Individuals with aortic valve stenosis and mitral valve stenosis.
•    Patients with low-grade pericarditis or pericardial tamponade;
•    Individuals prone to circulatory disturbances when standing;
•    Individuals with head injury, intracranial hemorrhage, or conditions with increased intracranial pressure;
•    Patients with severe anemia;
•    Individuals with narrow-angle glaucoma (nitrates may increase intraocular pressure);
•    Concurrent use with compounds generating nitrogen monoxide and phosphodiesterase inhibitors (sildenafil, vardenafil, tadalafil).

2. Usage and dosage of Nitromint

Usage: Patients should take Nitromint orally. It is recommended to take Nitromint before meals, swallowing the tablet whole with a small amount of water. Do not chew or crush the tablet.

Dosage: Varies for each patient, depending on the patient's health and condition.

•    Usual initial dose: 1 slow-release Nitromint 2.6mg tablet twice daily, which can be increased up to 2-3 tablets twice daily. It is recommended to take the medication twice daily, in the morning and early afternoon. If the pain mainly occurs at night, the doses should be taken in the morning and before bedtime;
•    Dosage for special populations:
•    Nitromint has the risk of causing orthostatic hypotension in elderly patients, so it is recommended to start with a lower dose and increase it more slowly in this group;
•    The safety and efficacy of Nitromint have not been established in children;
•    There is no need to increase the dosage of Nitromint in patients with liver or kidney impairment.

Overdose: In the case of a Nitromint overdose, the symptoms of side effects will become more severe. Depending on the level of overdose, patients may experience hypotension (with orthostatic blood pressure regulation disorders), fainting, circulatory collapse, reflex tachycardia, headache, weakness, blurred vision, dizziness, restlessness, drowsiness, flushed skin, nausea, vomiting, and diarrhea. Taking a high dose of Nitromint can cause bluish skin, difficulty breathing, rapid breathing, and seizures. Very high doses of Nitromint can cause increased intracranial pressure. Long-term Nitromint overdose can increase methemoglobin levels.

If a Nitromint overdose occurs, the following steps should be taken: promptly remove any substances from the stomach via early gastric suction and lavage. Place the patient on their back with elevated legs, continuously monitor vital signs, and make necessary adjustments in a controlled care setting. If the patient experiences significant hypotension and shock, supportive fluid therapy is crucial. In exceptional cases, intravenous administration of dopamine or noradrenaline may be required to restore circulation. For patients with methemoglobinemia, the severity will dictate the appropriate antidote: Vitamin C (1g orally or intravenously as sodium salt), methylene blue (up to 50ml of a 1% solution, intravenously), or toluidine blue (initial dose of 2-4ml/kg intravenously, with the possibility of repeating the treatment at 1-hour intervals with a dose of 2ml/kg). Additional treatments may include oxygen therapy, hemodialysis, or blood transfusion.

Missed dose: If you miss a dose of Nitromint, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and take the next dose at the regular scheduled time. Avoid taking a double dose to make up for the missed one.

3. Side effects of Nitromint

When using Nitromint, patients may experience some side effects, such as:

•    Headache: Nitrate-induced headaches are common during the initial stages of treatment. The severity depends on the dose and may subside after a few days without discontinuing the medication. Pain relievers can be used if necessary. If the dose needs to be reduced, it can be increased gradually later on;
Rare side effects at the start of treatment or after dosage increase include hypotension, orthostatic hypotension with symptoms like increased heart rate, dizziness, lightheadedness, and weakness;
•    Nausea and vomiting: These are rare side effects;
•    Flushing of the face, restlessness, blurred vision, dry mouth, skin rashes, circulatory collapse, sometimes slow heart rate, fainting. Excessive hypotension may worsen angina symptoms in some cases;
•    Palpitations, swelling of the legs and ankles, reflex hypertension, loss of taste (related to nitrate use);
•    Very rare: Methemoglobinemia can occur;
•    Continuous use of Nitromint (three times a day in the morning, afternoon, and evening) can lead to nitrate tolerance and cross-tolerance with other nitrate derivatives.

If you experience any serious side effects, it is important to stop taking Nitromint and notify your doctor or visit the nearest medical facility for prompt and timely treatment.

4. Precautions when using Nitromint

Here are some important precautions to keep in mind before and during the use of Nitromint:

•    The safety and efficacy of Nitromint have not been established in children;
•    Nitromint is not suitable for treating acute angina attacks. In such cases, patients should use medications with immediate effects;
•    Patients using nitroglycerin for an extended period should reduce and discontinue it gradually when switching to another medication;
•    Nitroglycerin can temporarily reduce arterial oxygen levels by increasing blood flow to poorly ventilated alveolar regions. In patients with coronary artery disease, this effect may reduce myocardial circulation and cause myocardial ischemia. Therefore, caution is needed when using Nitromint in patients with cardiopulmonary disease or arterial hypoxemia;
•    The initial dose of Nitromint should be lower and increased more slowly in elderly patients, as they are at higher risk of orthostatic hypotension;
•    Special caution is necessary when using nitroglycerin in patients with severe liver or kidney disease, mitral valve prolapse, hypothyroidism, low body temperature, malnutrition, or recent myocardial infarction;
•    During treatment, the frequency of angina attacks may increase during periods of low nitrate concentration. Adjunctive treatment with another anti-anginal medication may be needed to prevent attacks;
•    Avoid consuming alcohol during Nitromint treatment, as it can cause severe headaches, hypotension, and circulatory collapse;
•    Each slow-release Nitromint 2.6mg tablet contains 23.5mg of lactose. Use caution in patients with lactase deficiency, galactosemia, or glucose/galactose malabsorption syndrome;
•    When starting treatment, Nitromint may affect the ability to drive and operate machinery, so users should exercise caution;
•    Do not use Nitromint during pregnancy, especially in the first trimester, unless specifically directed by a doctor;
•    Do not use Nitromint while breastfeeding unless specifically directed by a doctor.

5. Drug interactions with Nitromint

Some interactions of Nitromint include:

•    Concurrent use with antihypertensive medications, vasodilators, calcium channel blockers, beta-blockers, diuretics, tricyclic antidepressants, sedatives, or alcohol can enhance the blood pressure-lowering effects of nitroglycerin;
•    Patients previously using organic nitrates (e.g., isosorbide mononitrate or dinitrate) may require higher doses of nitroglycerin to achieve the same effect. Concurrent use with dihydroergotamine can increase blood dihydroergotamine levels, enhancing its vasoconstrictive effects, potentially leading to hypertension and ischemia;
•    Concurrent use heparin with nitroglycerin may reduce the effectiveness of heparin;
•    Phosphodiesterase inhibitors (like sildenafil, vardenafil, and tadalafil) can potentiate the blood pressure-lowering effects of nitrates, leading to severe cardiovascular complications, including death. Therefore, combining these drugs is contraindicated;
•    Laxatives can shorten the intestinal transit time of Nitromint slow-release tablets, reducing the absorption and plasma concentration of nitroglycerin.

When using Nitromint, patients should follow all instructions from their doctor regarding usage and dosage. In case of missed doses, overdoses, or experiencing side effects, patients should immediately report to their doctor for appropriate advice.

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