Nitromint, spray sublingual

Prospect

Forma de prezentare:
Spray sublingual 0,4 mg/doza; cutie x 1 fl. x 10 g (180 doze)


Indicatii:
Cpr. obisnuite (bucale): trat. crizelor de angina pectorala, tratamentul preventiv pe termen foarte scurt (sau precritic) al crizelor anginoase. Trat. profilactic al crizelor de angina pectorala. Formele retard: profilaxia si trat. anginei de efort si vasospastice. In insuficienta cardiaca pentru suplimentarea trat. digitalic si diuretic. Forma retard nu se administreaza in tratamentul atacului de angina pectorala. spray subling.: Prevenirea atacului anginos prin administrarea inaintea efortului fizic. terapia adjuvanta in cazurile urgente de IC stanga (astm cardiac). Pentru scaderea presiunii de umplere in IMA. Sol. inj. IMA cu si fara insuficienta ventriculara stanga. insuficienta ventriculara stanga cu EPA si subacut. Criza hipertensiva cu decompensare cardiaca.


Doze si recomandari:
Cpr. bucale: Perlingual cate 1/2-1 cpr. In timpul crizelor de angina pectorala sau imediat inaintea efortului provocator. Doza se poate repeta dupa 15 minute. Daca dupa administrarea a 3 doze sub forma de cpr. criza de angina nu cedeaza, se recomanda prezentarea la medic pentru suspiciune de IMA. Dispozitive transdermice: Se aplica pe piele intr-o zona sanatoasa, uscata si curata, cu pilozitate redusa. Se incepe cu Nitroderm TTS 5, cate un sistem pe zi. Ulterior, in cazul unui raspuns nesatisfacator, se poate trece la Nitroderm TTS 10, un sistem zilnic. Daca apar fenomene de tahifilaxie, se foloseste tratamentul intermitent, cu interval liber de 8-12 ore pe zi, mai ales in cursul noptii. Cpr. ret.: uzual 1 cpr. de 2 ori/zi inainte de masa (dimineata si la pranz). Daca este necesar doza se poate creste la 2-3 cpr. de 2 ori/zi. in IC trebuie facuta o pauza de cateva zile dupa o perioada de tratament de 1-2 saptamani. spray subling.: in atac anginos se adm. 1-2 doze sublingual, in pozitie sezanda. Daca este necesar doza se poate majora la maximum 3 doze in decurs de 15 minute Pentru prevenire trebuie aplicata o doza cu 5-10 min inainte de exercitiul fizic. Sol. inj.: 0,75-8 mg nitroglicerina/ ora; se va incepe intotdeauna cu doze mici. Se monitorizeaza TA sistolica si diastolica, frecventa cardiaca si daca este nevoie: presiunea arteriala pulmonara sistolica si diastolica, presiunea de umplere a ventriculului stang, debitul cardiac si ekg (masurarea segmentului ST). Trinitrosan poate fi adm. numai sub forma de perfuzie. Dilutia intr-o sol. perfuzabila compatibila este de cel putin 1:4, iar durata tratamentului se poate extinde la 3 zile sau mai mult.


Contraindicatii
IC, glaucom, tromboza coronariana acuta, ramolisment cerebral, hipertensiune arteriala posturala, hipertensiune intracraniana, idiosincrazie la nitroglicerina; stari de soc si colaps, anemii grave. Infarct miocardic cu presiune de umplere scazuta; insuficienta circulatorie (soc, colaps); edem pulmonar toxic (adm. intravenos); cardiomiopatie hipertrofica obstructiva; hipertensiune arteriala marcata. sarcina si alaptare.


Atentionari:
Daca apare cianoza, fara pneumopatie intercurenta, se dozeaza methemoglobina. Dispozitivele transdermice nu se recomanda in trat. crizei anginoase acute. In astfel de cazuri se vor asocia nitrati cu actiune rapida. in caz de IMA sau IC acuta, trat. se va face numai sub stricta supraveghere medicala. in cazul unei hipoxii arteriale severe (anemii severe), se va trata mai intai anemia si ap si se incepe aplicarea sistemului transdermic. In cazul aparitiei unei crize anginoase in perioada “libera de plasture” se va face un tratament antianginos concomitent. Se evita intreruperea brusca a tratamentului datorita riscului unei crize anginoase. Nitratii pot decompensa o cardiomiopatie hipertrofica. soferi si activitati de precizie, mai ales la inceputul tratamentului.


Reactii adverse:
Cefalee, tahicardie, scaderi ale TA (cu ameteli, slabiciune), greata, voma, roseata fetei, dezorientare. In cazuri izolate, poate aparea bradicardie la inceputul administrarii.

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