Last Updated on February 19, 2017 by Dr.Derek Fhisher
Most popular brand: Furacin
Active ingredient: Nitrofurazone
Available dosage forms: 25 mg
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Nitrofurazone general information
The application of Nitrofurantoin must certanly be directed by an experienced doctor. Don’t utilize Nitrofurantoin beyond the suggested dosage too. Nitrofurantoin reaches the largest urine levels about a few hours after ingestion. Nitrofurantoin could be harmful to the fetus, specially in the last month before delivery.
NITROFURANTOIN is just one mercury. Never take two doses at the same time! Take nitrofurantoin carefully as prescribed by your physician. Thus take the following dose once it’s time for it.
Nitrofurantoin 100 mg is provided by the majority of online pharmacies. Stick to medicines your doctor says are safe to be used with Nitrofurantoin. Practice the directions on your own prescription label. Here you are able to read more regarding the effects and usage of Nitrofurantoin, side results and other essential details.
In case of allergies, a physician ought to be informed. Nitrofurantoin is not going to treat a viral infection like the typical cold or flu. Nitrofurantoin might cause drowsiness. The soap within the introversion base of info in this way.
Even in kids and adolescents a decrease within the dose is necessary. The existence of aforementioned conditions may require various formulations. These measurements will act as bases for creating a treatment program for this patient.
Inform your doctor in case you are pregnant or intend on becoming pregnant during treatment. Your own doctor would likewise ask about pregnancy or some plans of conceiving a kid. Speak to your doctor as quickly as possible should you be pregnant, have plans for pregnancy or should you be nursing. Call your physician for medical advice regarding side effects.
Nitrofurantoin is utilized to treat and protect against urinary tract infections. Don’t take any antidiarrhea medication unless it absolutely was administered to you personally as diarrhea can be an indication of a new infection. This medication might cause drowsiness. When bowing taking lower dosages are chosen, usually a single tablet within the evening following the previous urination. It ought to be avoided taken on a void stomach.
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Nitroglycerin (Nitroglycerin): instruction, and the use of a formula
substance Characteristics Nitroglycerin
A colorless oily liquid. Poorly soluble in water, well ; in alcohol, ether, chloroform.
Mode of action – antianginal, vasodilator, vasodilatig.
Increases of free radical nitric oxide (NO), that activates the guanylate cyclase and increases levels of cGMP (controls dephosphorylation of myosin light chain) in vascular smooth muscle cells. It extends primarily venous vessels, causing blood deposition in the venous system and decreases venous return to the heart (preload) and end-diastolic filling of the left ventricle. Systemic arterial vasodilation (widens mainly large arteries) is accompanied by a decrease in systemic vascular resistance and blood pressure. those. afterload. Reduced pre – and afterload on the heart leads to a decrease in myocardial oxygen demand; lowers high blood pressure and central venous pressure pulmonary capillary wedge; slight increases in heart rate (reflex tachycardia in response to a decrease in systemic blood pressure and stroke volume, more pronounced in the vertical position of the body), weakens the resistance of the coronary arteries and improves cardiac blood flow (except in cases of excessive reduction of systemic blood pressure or a significant increase in heart rate. When possible worsening of coronary blood flow ).
Extends large epicardial coronary arteries departments, enhances the pressure gradient at the site of atherosclerotic stenosis in coronary vessels, perfusion provides even if subtotal stenosis includes collaterals, including by reducing the resistance to blood flow through them. Redistributes coronary flow to ischemic areas in particular, subendocardial departments. In ischemic myocardial hypokinesia separate areas contributes to the restoration of local contractility. It eliminates abnormal myocardial stiffness and prevents the development of fatal arrhythmias in myocardial infarction. Reduces post-infarction left ventricular remodeling. Effectively inhibits platelet aggregation and adhesion to the vascular endothelium. Increases the threshold of myocardial ischemia.
In patients with heart failure and angina pectoris improves cardiac output, exercise tolerance and reduces the severity and frequency of attacks. Significantly reduces the amount of mitral regurgitation. It has a central inhibitory effect on sympathetic vascular tone, inhibiting the formation of the vascular component of pain. It normalizes the exchange of electrolytes and energy processes ; the ratio of oxidized and reduced forms of nicotinamide nucleotides, the activity of NAD – dependent dehydrogenases. Promotes release of catecholamines in the brain and the heart, has an indirect sympathomimetic effect on myocardium changes the conformation of the troponin – tropomiozinovogo complex. It promotes transition of hemoglobin to methemoglobin and may impair oxygen transport. It causes dilation of meningeal blood vessels, which is often accompanied by the appearance of a headache. It relaxes smooth muscles of the bronchi, biliary tract, esophagus, stomach, intestines, urinary tract.
Quickly and adequately absorbed from the surface of the mucous membranes and the skin. After ingestion largely destroyed in the liver (the effect of “first pass”), and then to form biotransformed NO in smooth muscle cells. In the context of sublingual, subbukkalnogo and / excluded in the application “primary” liver degradation (immediately reaches the systemic circulation). Primary metabolites are di – and mononitrates, end ; glycerol. With sublingual C max main metabolites (0,2 – 0,3 ng / ml) was achieved in 120 – 150, T 1/2 nitroglycerin 1 – 4,4 min, metabolites ; 7 min. The volume of distribution of 3 l / kg, clearance ; 0,3 – 1,0 l / kg / min. When administered as a spray into the mouth C max metabolites (14.6 ng / ml) was achieved after 5.3 minutes, the relative bioavailability of ; 76% T 1/2 ; 20 minutes. When administered 6.4 mg C max metabolites (0,1 – 0,2 ng / ml) was achieved in 20 – 60 min. Relative bioavailability 10 – 15%. T 1/2 metabolite is 4 hours on / in the introduction of the T 1/2 .; 1 – 3 min, total clearance ; 30 – 78 l / min, these indicators of heart failure is reduced to 12 to & minus; 1,9 min and 3.6 – 13.8 l / min, respectively. The plasma protein bound (60%). The metabolites are excreted primarily through the kidneys, of the lungs is excreted in the expired air.
When using the sublingual and buccal forms of angina docked in 1.5 minutes, and hemodynamic and anti-ischemic effects persist up to 30 minutes and 5 hours, respectively. Upon receiving the low dose (2.5 mg) hemodynamic effect lasts up to 0.5 hours, large (fort) ; 5 & ndash; 6 h (at doses of hemodynamic effect manifested 2 – 5 min, and after 20 antianginal – 45 min). ointment application ensures the development of anti-anginal action in 15 – 60 min and 3 – 4 hour duration. The effect of transdermal comes in 0,5 – 3 hours and lasts up to 8 – 10 am.
Application of the substance Nitroglycerin
CHD. exertional angina (treatment and prevention), vasospastic angina (Prinzmetal), unstable angina, coronary artery spasm during coronary angiography, acute coronary syndrome, acute myocardial infarction, acute left ventricular failure (cardiac asthma, interstitial and alveolar pulmonary edema), congestive heart failure controlled hypotension during surgical procedures, prevention of hypertensive reactions during endotracheal intubation, skin incision, sternotomy, occlusion of the central retinal artery, esophageal dyskinesia, functional holetsistopatii, acute pancreatitis, biliary colic, spastic intestinal dyskinesia.
Hypersensitivity, pronounced hypotension, collapse, myocardial infarction with low end-diastolic pressure in the left ventricle and / or severe hypotension (Sad below 90 mm Hg) or collapse, right ventricular infarction, bradycardia less than 50 bpm. / Min . primary pulmonary hypertension, stroke, head injury, increased intracranial pressure, cerebral ischemia, cardiac tamponade, toxic pulmonary edema, marked aortic stenosis, state, accompanied by a decrease in end-diastolic pressure in the left ventricle (isolated mitral stenosis, constrictive pericarditis), angle-closure glaucoma , pregnancy, breast-feeding.
Restrictions on the use
Anemia, hypertrophic cardiomyopathy (idiopathic hypertrophic subaortic stenosis), advanced age, severe liver and kidney disease, hyperthyroidism.
Application of pregnancy and breastfeeding
Application of pregnancy is possible only in cases where the expected benefit outweighs the potential risk to the fetus.
Category effects on the fetus by FDA ; C.
breast-feeding should be discontinued at the time of treatment.
Side effects of substance Nitroglycerin
From the nervous system and sensory organs: headache, dizziness, feeling of fullness of the head, weakness, restlessness, psychotic reactions, blurred vision, worsening of glaucoma.
From the cardio – vascular system and blood (blood, hemostasis): flushing, palpitations, hypotension, including orthostatic collapse, methaemoglobinaemia.
From the digestive tract: dry mouth, nausea, vomiting, diarrhea,
For the skin: cyanosis, flushing of the skin.
Allergic reactions: itching and burning, allergic contact dermatitis (using transdermal).
Other: hypothermia, heat sensation, paradoxical effects ; angina, ischemia until the development of myocardial infarction and sudden death; the development of tolerance.
Salicylates increase the level of nitroglycerin in plasma, barbiturates accelerate metabolism. Nitroglycerin reduces the pressor effect of agonists, the anticoagulant effect of heparin (with on / in the introduction). Antihypertensive, antiadrenergic drugs, vasodilators, sildenafil citrate, calcium channel blockers, tricyclic antidepressants, MAO inhibitors. ethanol, quinidine and procainamide increase the hypotensive effects and systemic vasodilator. Methionine, N – acetylcysteine, ACE inhibitors increase and salicylates antianginal activity. Unitiol restores the reduced sensitivity to nitroglycerin. Dihydroergotamine, m – anticholinergics, alpha – adrenoceptor agonists, histamine, pituitrin, corticosteroids, CNS stimulants and autonomic ganglia, poisons bees and snakes, excessive sun exposure and reduce the vasodilatory effects of antianginal.
Symptoms: headache, dizziness, feeling of heavy pressure in the head unusual tiredness or weakness, fainting, hot flashes or chills, sweating, palpitations, nausea and vomiting, cyanosis of the lips, fingernails, or palms , dyspnea, hypotension, weak rapid pulse, increased body temperature, increased intracranial pressure (brain symptoms until the development of seizures, and coma), methemoglobinemia.
Treatment: translation of the patient in a horizontal position (legs raised above the level of the head to increase venous return to the heart), gastric lavage (if from the moment of ingestion was not long), plasma expanders, in / to the introduction alpha agonists – adrenergic (phenylephrine). Avoid introduction as a cardiac agent of epinephrine – the possibility of strengthening shock-like reactions. To eliminate methemoglobinemia using oxygen under pressure or 1% solution methylthioninium chloride (methylene blue) in a dose of 1 – 2 mg / kg / to. Recommended monitoring methemoglobin concentration in the blood.
Dosing and Administration
B / (dilute 5% glucose solution, or isotonic saline to a final concentration of 50 or 100 .mu.g / ml): 0.005 mg / min, the dose is increased at 0.005 mg / min every 3 – 5 minutes to obtain the effect of achieving the speed or 0.02 mg / min (inefficiencies ; further increase of 0.01 mg / min).
Sublingual: Tablets ; 0.15 – 0.5 mg per reception, if necessary again after 5 minutes; Spray ; for the relief of angina ; 1 – 2 sublingual dose by pressing the dispensing valve (may be repeated, but no more than 3 doses within 15 min). In the case of acute left ventricular failure may use 4 or more doses in a short period.
Transdermal: tag on each time a new area of skin and leave for 12 – 14 hours, then removed to provide a break for 10 – 12 hours to prevent the development of tolerance.
Inside: , tablets and capsules taken without chewing or breaking a 2 – 4 times a day before meals, preferably 30 minutes before exercise, a single dose of 5 – 13 mg; from – to poor bioavailability of a single dose may be increased up to 19.5 mg.
Subbukkalno: tablet is placed on the oral mucosa (the cheek) and hold until resorption: 2 mg 3 times a day.
Precautions substance Nitroglycerin
In the acute phase of myocardial infarction and in the development of acute heart failure prescribed under the strict control of hemodynamics. To use caution in aortic and mitral stenosis, in patients with hypovolemia and reduced Sad (less than 90 mm Hg). In hypertrophic cardiomyopathy can cause increased frequency and / or worsening of angina attacks. Prolonged uncontrolled receiving nitroglycerin, high doses to patients with hepatic insufficiency and children increases the risk of methemoglobinemia, cyanosis, and manifested in the appearance of the blood brown. In cases of methemoglobinemia drug is an urgent need to cancel and enter antidote ; methylthioninium chloride (methylene blue). If necessary, further use of nitrates required control over the content of methemoglobin in the blood, or the replacement of nitrates on sydnonimine.
To reduce the risk of adverse effects should be careful while taking medicine, has a pronounced antihypertensive and vasodilating properties; it is not recommended taking the drug on a background of alcohol in areas with high ambient temperatures (room, a sauna, a hot shower), as well as taking multiple pills at the same time or sequentially in a short period of time when the first reception.
You can not chew the tablets and capsules in order to stop an attack of angina pectoris, because into the systemic circulation can do an excessive amount of drug from the destroyed microcapsules through the oral mucosa. When the headache and other unpleasant sensations in the head improvement is achieved validol appointment or menthol drops sublingually. Often poorly tolerated, only the first dose, then the side effects subside.
While the use of heparin is necessary to increase the dose of heparin, and strictly control the activated partial thromboplastin time. Used with caution in elderly patients. Not recommended the appointment of buccal forms to patients with aphthous stomatitis, gingivitis, periodontal disease and tooth root system, removable upper denture.
Uncontrolled intake can lead to the development of tolerance, which is expressed in reducing the duration and severity of the effect with regular use, or the need to increase the dose to achieve the same effect. With regular use of nitroglycerin depot forms, especially plasters and ointments, almost all the time the drug is present in the blood, so the risk of development of tolerance is increased significantly. To prevent the occurrence of sustainability requires intermittent reception during the day, or co-administration of calcium antagonists, ACE inhibitors. or diuretics. Transdermal forms nitroglycerin is recommended to remove from the body at night, thus leaving a period free from the drug. It should guard against the development of withdrawal symptoms associated with abrupt discontinuation of nitroglycerin into the organism and manifested by a sudden development of angina attacks.
When / in a possible development of tachyphylaxis, which requires a change in the dosage upward. The degree of tolerance can be judged by the dynamics of the pressure in the right atrium. Approximation indicator of tolerance to 25% required discontinuation of administration of the solution. Simulate the development of tolerance when administered intravenously can decrease the content of nitroglycerin in the solution of – for violations of technology introduction, the destruction of nitroglycerin with the direct impact of light rays or absorption on the walls of the plastic infusion system (20 – 80% using systems of polyvinyl chloride, polystyrene – butadiene propionate cellulose, latex or polyurethane). It is recommended to use a system of chemically pure glass, polyethylene, nylon, Teflon, and silicone. Do not use too long hydraulic lines. The on / in the introduction of nitroglycerine must be borne in mind that after the termination of infusion and transfer the patient to tablets (even long-acting) Nitrates may be canceled or insufficient dose of the syndrome, and the possible increase in the incidence of complications in acute myocardial infarction ; increased frequency of angina attacks, the growing phenomena of circulatory failure, recurrence of myocardial infarction, acute heart aneurysm formation, increase in the frequency of myocardial breaks.
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