ANGININE

Anginine Information

Anginine is indicated for the treatment of acute attacks of angina pectoris including variant angina and for the prophylaxis of such attacks.

Anginine Warnings

Anginine should be used with caution in patients with cerebrovascular disease since symptoms may be precipitated by hypotension. ANGININE may worsen hypoxaemia in patients with lung disease or cor pulmonale. Arterial hypotension with bradycardia may occur in patients with myocardial infarction; this is thought to be reflexly mediated. The use of Anginine could theoretically compromise myocardial blood supply in patients with left ventricular hypertrophy associated with aortic stenosis because of the detrimental effects of tachycardia and decreased aortic diastolic pressure. Use During Pregnancy and Lactation: The administration of glyceryl trinitrate during pregnancy should only be considered if the expected benefit to the mother is greater than any possible risk to the foetus. No data are available on the excretion of Anginine or its metabolites in human breast milk.

Drug Interaction: The risk of hypotension and syncope with use of Anginine may be enhanced by alcohol. The possibility of tolerance to the effects of Anginine should be considered when used in conjunction with long-acting nitrate preparations. Consistent with its known effects on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway, sildenafil has been shown to potentiate the hypotensive effects of nitrates, and its coadministration with ANGININE is therefore contraindicated. In vitro data suggest that St John's Wort (Hypericum perforatum) may induce cytochrome P450 3A4. There is a theoretical possibility therefore, that plasma levels of glyceryl trinitrate may be decreased during concomitant administration and increased upon withdrawal of St John's Wort. Contraindications: Anginine is contraindicated in angina caused by hypertrophic obstructive cardiomyopathy as it may exaggerate outflow obstruction. Anginine should not be used in patients with cerebral haemorrhage or head trauma. Anginine is contraindicated in patients taking sildenafil.

Anginine Side Effects

The dose of Anginine may be limited by vascular headaches. Other side effects are facial flushing, tachycardia, light-headedness, dizziness, halitosis, hypotension, syncope and rarely bradycardia. Large doses may cause vomiting, cyanosis, restlessness, methaemoglobinaemia and impairment of respiration. Headache and/or light-headedness persisting after relief of angina may be minimised by removing the Anginine tablet before it has completely dissolved. Anginine-induced hypotension may cause cerebral ischaemia. It occasionally causes a drug rash.

Anginine Overdose

In the case of ingestion, all that is usually required is supportive treatment of the cardiovascular and respiratory systems. The patient should be nursed head-down if hypotensive. Arterial blood gas estimation should be performed and if there is acidosis or the patient is clinically cyanosed, then severe methaemoglobinaemia must be assumed. Oxygen therapy should be given with 1 to 2mg/kg bodyweight of intravenous Methylene Blue over 5 minutes.

Anginine Usage guidelines

Anginine must be placed under the tongue (administered sublingually) and retained in the mouth until dissolved or discarded. A local burning or tingling sensation may occur. When angina starts 0.6mg glyceryl trinitrate (one tablet) should be taken every 3 minutes until cessation of pain or limiting side effects, such as headache or light-headedness supervene. The patient should preferably rest in the sitting position because of the risk of symptomatic postural hypotension. Anginine tablets should be discarded after eight weeks in use. Store below 25°C.

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