Nitrocard Spray

Nitrate vasodilator for:

• Sublingual spray/tablet: quick relief of angina attacks, and prevention before exertion
• Sustained-release tablets/patches: prevention of angina (long-term)
• IV infusion (hospital): unstable angina, acute heart failure, blood pressure control during surgery
• Rectal ointment 0.4%: chronic anal fissure pain

Sublingual spray (400 mcg/dose): 1–2 sprays under the tongue at the start of an attack (or 5 minutes before exertion); close the mouth after spraying. May repeat after 5 minutes. If pain is not relieved 5 minutes after the second dose (or 15 minutes total), call an ambulance.

Sublingual tablet 0.3–0.6 mg: dissolve under the tongue, same rules.

Sustained-release tablets 2.6–6.4 mg: two or three times daily (allow a nitrate-free period, usually overnight).

Patch 5–15 mg/24 h: apply once daily and remove after 12–14 hours (nitrate-free interval to prevent tolerance).

Rectal ointment 0.4%: about 1 inch (375 mg ointment) to the anal canal every 12 hours for up to 8 weeks.

• Sit down before using — it may cause dizziness.

• Use with PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) or riociguat — dangerous drop in blood pressure
• Severe low blood pressure, shock, hypovolaemia
• Hypertrophic obstructive cardiomyopathy, severe aortic or mitral stenosis, cardiac tamponade, constrictive pericarditis
• Raised intracranial pressure (head injury, brain bleed)
• Severe anaemia, closed-angle glaucoma (relative)
• Allergy to nitrates

Very common: headache (usually eases with continued use), flushing, dizziness, low blood pressure on standing.

Common: fast heartbeat, nausea, weakness, fainting.

Patch/ointment: skin irritation; anal burning (ointment).

Rare: methaemoglobinaemia with high doses, severe low blood pressure with slow heart rate.

• Sit or lie down when taking a dose; get up slowly.
• Avoid alcohol (more low blood pressure).
• Tolerance develops with continuous use — keep a daily nitrate-free period.
• Carry the spray/tablets at all times if prescribed for angina; replace sublingual tablets as directed after opening.
• Seek urgent help for chest pain lasting over 15 minutes.

Use in pregnancy only if clearly needed. Limited data in breastfeeding — use only if needed.

• Sildenafil, tadalafil, vardenafil, avanafil, riociguat (contraindicated — severe hypotension, possibly fatal)
• Other blood-pressure-lowering drugs, alcohol, tricyclic antidepressants, antipsychotics (more hypotension)
• Heparin (IV GTN may reduce its effect)

Severe headache, low blood pressure, fainting, fast heartbeat, flushing, vomiting; methaemoglobinaemia (bluish skin). Lie down with legs raised; emergency care.

Store below 25–30°C. Sublingual tablets: keep in the original glass bottle, tightly closed; discard 8 weeks after opening. Spray: do not puncture or burn.