Angicard Sublingual Tablet

Introduction

Angicard Sublingual Tablet 0.5 mg is a medication used primarily for the treatment of angina pectoris (chest pain) associated with coronary artery disease. It is a nitrate-based vasodilator that helps to reduce the workload on the heart by dilating blood vessels, improving blood flow, and decreasing myocardial oxygen demand.

Uses

Angicard Sublingual Tablet 0.5 mg is used for:

Relief of angina pectoris in patients with coronary artery disease.
Management of chronic stable angina and acute angina attacks.
As a preventive measure before activities known to trigger angina.
In some cases, it is used in the treatment of heart failure and acute myocardial infarction (in hospital settings).

Brand Name	Angicard
Type	Sublingual Tablet
Weight	0.5 mg
Generic	Nitroglycerin
Manufacturer	Drug International Ltd.
Available in	English বাংলা

Mechanism of Action

Angicard Sublingual Tablet 0.5 mg works by releasing nitric oxide, which relaxes smooth muscle cells in blood vessels. This vasodilation reduces the amount of blood returning to the heart (preload) and decreases the resistance the heart must work against (afterload). This leads to a decrease in myocardial oxygen demand and helps relieve angina symptoms.

How Long Does It Take to Work?

The onset of action for nitroglycerin depends on the route of administration. Sublingual nitroglycerin tablets typically act within 1-3 minutes. The effects of topical nitroglycerin (e.g., patches) may take longer to manifest, with peak effects occurring in 30-60 minutes. Oral sustained-release formulations generally take about 30 minutes to 1 hour to achieve therapeutic levels.

Absorption

Angicard Sublingual Tablet 0.5 mg is absorbed differently depending on the formulation:

Sublingual tablets are rapidly absorbed through the mucous membranes in the mouth.
Topical nitroglycerin is absorbed through the skin, though absorption may be variable based on the application site.
Oral sustained-release formulations are absorbed through the gastrointestinal tract, with variable bioavailability due to first-pass metabolism.

Route of Elimination

Angicard Sublingual Tablet 0.5 mg is primarily metabolized in the liver by the enzyme glutathione S-transferase. The metabolites are then excreted through the urine. The drug has a short half-life and is eliminated relatively quickly from the body.

Dosage

The dosage of nitroglycerin varies based on the formulation and condition being treated:

Sublingual tablets: 0.3 to 0.6 mg, taken every 5 minutes as needed for angina, up to 3 tablets in a 15-minute period.
Topical ointment: 1 to 2 inches applied to the skin every 6 to 8 hours.
Transdermal patches: 0.1 to 0.8 mg/hour applied once daily, typically worn for 12-14 hours followed by a nitrate-free period.
Oral sustained-release tablets: 2.5 to 6.5 mg twice daily.

Administration

Angicard Sublingual Tablet 0.5 mg can be administered in various forms:

Sublingual tablets are placed under the tongue and allowed to dissolve.
Topical ointment is applied to clean, dry skin on the chest, back, or upper arm.
Transdermal patches are placed on a clean, dry area of the skin and left in place for a specified duration.
Oral sustained-release tablets are taken by mouth with water, preferably on an empty stomach.

Side Effects

Common side effects of nitroglycerin include:

Headache
Dizziness
Flushing
Nausea
Hypotension (low blood pressure)

Serious side effects may include severe hypotension, syncope (fainting), and severe allergic reactions. Seek medical attention if these occur.

Toxicity

Symptoms of nitroglycerin overdose may include severe hypotension, tachycardia (rapid heartbeat), severe headaches, and methemoglobinemia (a condition where blood cannot carry oxygen effectively). In cases of suspected overdose, seek emergency medical help immediately.

Precautions

Precautions include:

Monitoring blood pressure regularly, as nitroglycerin can cause significant drops in blood pressure.
Using caution in patients with a history of hypotension, hypovolemia, or severe anemia.
Avoiding abrupt discontinuation to prevent rebound angina.
Informing healthcare providers of any other medications being taken to avoid interactions.

Interaction

Angicard Sublingual Tablet 0.5 mg interactions may include:

Phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil) may cause severe hypotension when used concurrently with nitroglycerin.
Antihypertensives may enhance the hypotensive effect of nitroglycerin.
Alcohol can exacerbate the side effects of nitroglycerin, particularly hypotension and dizziness.

Disease Interaction

Patients with the following conditions should use nitroglycerin with caution:

Severe liver or kidney disease, which may affect drug metabolism and clearance.
Severe anemia or volume depletion, which increases the risk of hypotension.
Recent myocardial infarction or congestive heart failure.

Drug Interaction

Drug interactions with nitroglycerin include:

Other nitrates or nitrites can cause additive hypotensive effects.
Antihypertensive drugs can enhance the blood pressure-lowering effects of nitroglycerin.
Medications that affect liver enzymes (e.g., certain antifungals) may alter nitroglycerin metabolism.

Food Interactions

There are no significant food interactions with nitroglycerin. However, excessive alcohol consumption can amplify the hypotensive effects and should be avoided.

Pregnancy Use

Angicard Sublingual Tablet 0.5 mg should be used during pregnancy only if clearly needed. It is classified as Category C by the FDA, meaning that risk cannot be ruled out. Consult a healthcare provider to weigh the benefits and risks before use.

Lactation Use

Angicard Sublingual Tablet 0.5 mg is excreted in breast milk in small amounts. While it is generally considered safe for use during lactation, consult a healthcare provider to discuss potential risks and benefits.

Acute Overdose

In the event of acute overdose, symptoms may include severe hypotension, syncope, and methemoglobinemia. Treatment involves supportive measures and possibly administration of intravenous fluids and medications to manage blood pressure and symptoms.

Contraindication

Contraindications for nitroglycerin include:

Hypersensitivity to nitroglycerin or other nitrates.
Severe hypotension or shock.
Concurrent use with phosphodiesterase-5 inhibitors.
Increased intracranial pressure or head trauma.

Use Direction

Follow the prescribed dosage and administration instructions provided by a healthcare provider. For sublingual tablets, place under the tongue and allow to dissolve. For topical and transdermal forms, apply as directed and avoid applying to broken skin. Oral tablets should be taken as directed, usually on an empty stomach.

Storage Conditions

Store nitroglycerin in a cool, dry place, away from moisture and light. Keep it in its original container to protect it from degradation. For topical and transdermal forms, follow specific storage instructions provided by the manufacturer.

Volume of Distribution

The volume of distribution for nitroglycerin is not explicitly defined, but it is distributed widely throughout the body. It crosses the blood-brain barrier and placenta.

Half Life

The half-life of nitroglycerin is very short, ranging from 1 to 4 minutes, due to rapid metabolism and clearance from the body.

Clearance

Angicard Sublingual Tablet 0.5 mg is cleared from the body primarily through hepatic metabolism. Its clearance rate is influenced by liver function and systemic blood flow.

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