Cardiovascular – Renal Drugs : Antianginal Agents
IMILL1 “Millisrol injection” 0.5 mg/ml; 10 ml/amp
INTG1 “N.T.G. Premixed injection” 0.2mg/ml; 250ml/bot
ONITR2 “Nitrostat SL tablet” 0.6 mg/tab
ONITR1 “Nitrocontin continus tablet” 2.6 mg/tab
Millisrol:
[泡法]
5amp in G5W 200ml run 3-6ml/hr
[備註]
(1) 通常使用3天
(2) 禁：右心心肌梗塞、24小時內有服用威爾鋼者
適應症：
IMILL1, INTG1：在手術中或其前後高血壓情況之血壓控制、急性心肌梗塞導致的鬱血性心衰竭、有機硝酸鹽類或B-阻斷劑、未產生反應之狹心症、外科手術時用以產生控制性低血壓。
ONITR2：狹心症之治療及預防。
ONITR1：對狹心症之預防可能有效。
Usual dose:
Angina, not responsive to to sublingual nitroglycerin and beta-blockers: IV
Adult: initial, 5 mcg /min IV using nonabsorptive tubing, titrate 5 mcg/min q3-5min to response; if no response is seen at 20 mcg/min, incremental increases of 10 and 20 mcg/min may be used; starting dose of 25 mcg/min has been used in clinical studies using PVC tubing.
Angina, prophylaxis: PO, SL.
Adult: 1 tab 5-10 min before activity which might induce an attack.
Angina, acute: PO, SL
Adult: 1 tab at first sign of attack; repeat q5min if needed for a total of 3 tablets in 15 min; if no relief, seek medical attention promptly.
Congestive heart failure – Myocardial infarction with complication: IV
Adult: non-PVC tubing, 5 mcg/min, initial titration should be in 5 mcg/min increments at intervals of 3-5 min guided by p’t response; if no response is seen at 20 mcg/min, incremental increases of 10 and 20 mcg/min may be used; PVC tubing, initial dose 25 mcg/min IV.
Pediatric: initial 0.25-0.5 mcg/kg/min; maintenance 1-3 mcg/kg/min, max. 5 mcg/kg/min.
Hypertension, Perioperative: IV
Adult: 5 mcg/min, initial titration should be in 5 mcg/min increments at intervals of 3-5 min guided by p’t response; if no response is seen at 20 mcg/min, incremental increases of 10 and 20 mcg/min may be used.
Pulmonary edema: IV
Adult: initial, 5-10 mcg /min, titrate in increments of 5 mcg/min q3-5min to total dose of 100-200 mcg/min until desired hemodynamic effect obtained; systolic arterial pressure should be kept in the range of 90-100 mmHg.
Pediatric: initial, 0.5-20 mcg/kg/min; max. 60 mcg/kg/min.
Dose adjustment:
Geriatric: lower initial doses are recommended.
Contraindication:
Anemia, severe (SL); concurrent use of phosphodiesterase inhibitors such as sildenafil or vardenafil (increased hypotensive effect).
Constrictive pericarditis (IV), early myocardial infarction (SL).
Increased intracranial pressure (SL), pericardial tamponade (IV), restrictive cardiomyopathy (IV), symptomatic hypotension.
Adverse effect:
Common: hypotension, tachyarrhythmia, rash ,aptyalism, asthenia, dizziness, headache, lightheadedness, disorder of vision.
Serious: rebound hypertension, syncope, unstable angina, scaling eczema, blood coagulation disorder with prolonged bleeding time, methemoglobinemia, thrombocytopenia.