Nitropuff®

Patient Information

Glyceril tri nitrate (GTN) is one of a group of medicines called ‘nitrates’. These relax the muscles around the blood vessels and make it easier for the heart to do its work.

What Nitropuff^® is used for:

Nitropuff^® is a sublingual spray which you use under your tongue. The active ingredient is called glyceryl trinitrate or GTN for short. Nitropuff^® helps stop the pain of angina (pain in your chest, arms or neck especially when you exert yourself).You can also use the medicine immediately before doing things which you know will cause you angina pain.

Do not take Nitropuff^® if:

• You are allergic (hypersensitive) to nitrates or any of the other ingredients of Nitropuff^® .
• You are very ill because of very low blood pressure, severe blood loss, a stroke, bleeding in the brain, a severe head injury or severe anaemia.
• You have certain unusual heart conditions (such as acute circulatory shock, including Hypovolaemic shock, uncontrolled cardiogenic shock, severe mitral stenosis or hypertrophic obstructive cardiomyopathy), which your doctor will have told you about.
• You are taking sildenafil or similar products (e.g.,vardenafil, tadalafil) for the treatment of erectile dysfunction or hypertension of arterial lung vessels.
• You take these products and Nitropuff^®, a severe and possibly dangerous fall in blood pressure can occur. This would result in collapse, unconsciousness and could be fatal.

Tell your doctor or pharmacist before using Nitropuff^® if :

• You have an eye condition called incipient glaucoma.
• You have mitral stenosis.
• You feel dizzy when you sit or stand upright suddenly.
• You have cerebrovascular disease.
• You have pericardial tamponade.
• You have constrictive pericarditis.
• You have low blood oxygen in lung disease or pulmonary heart disease.
• You have had a heart attack
• You have left ventricular hypertrophy.
• You have moderate to severe valvular aortic stenosis.

Know all the medicines you take. Keep a list of them with you to show your doctor and pharmacist.

How to take your Nitropuff^®:

Always take this medicine exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. The spray is meant for use under your tongue and is not meant to be inhaled. The recommended dose is one or two puffs under your tongue. If symptoms do not resolve, you can repeat this at 5 minute intervals for a maximum of two more times, for a total of three doses. If, after that, your symptoms have still not resolved, please seek immediate medical attention. The spray should work quickly and last about half an hour. Before you use a new bottle of Nitropuff^®, spray the first puff into the air to get the pump working properly. You must also do this if you have not used the pump for a week or more. Get used to the feel of the grooved button in case you need to use the pump in the dark.

1. Rest or sit quietly, as you may feel faint or dizzy otherwise, particularly if you are elderly.
2. Hold the bottle upright with your finger on the button. You don’t need to shake the bottle.
3. Open your mouth and put the bottle next to your chin (see picture).

4. Press the button firmly so that the puff of medicine goes under your tongue. Close your mouth.
5. Do not breathe in while you are taking the puff of medicine. Keep the spray with you at all times. Through the side of the bottle you can see how much spray you have left. Make sure that you get a new spray before the old one runs out. Always keep a spare. Talk with your doctor about how long you should keep taking Nitropuff^®.

What to do if you forget to take a dose :

Do not take a double dose to make up for a forgotten dose.

 While taking your medicine :

• If you drink alcohol before using Nitropuff^®, you may feel dizzy or faint due to low blood pressure.
• You should wait at least five minutes after using the spray before driving or operating machinery. If you feel faint, dizzy or unwell after using Nitropuff^®, wait until you feel better before driving or operating machinery.

Call your doctor right away if you have:

• While taking Nitropuff^®, tell your doctor if the spray does not stop the pain; or if the spray usually works, but this time the pain lasts longer (half an hour or more), or feels different or worse than usual.

What to do if you take too many Nitropuff^® :

If you take too many puffs you may notice more severe and pronounced side effects, for example, you may get a bad headache, blurred vision, feel flushed or feel that your heart is beating more slowly. You may also feel faint, sweaty, breathless, weak, restless and feel sick or be sick, or notice a bluish tinge to your lips. If any of these effects persist contact your doctor or pharmacist.

 Side effects :

Like all medicines, this medicine can cause side effects, although not everybody gets them.

The following side effects have been reported:

Very common: headache

Common: decreased blood pressure, which can also occur on standing up; weakness; dizziness;

drowsiness; increased heart rate

Uncommon: fainting; worsened angina symptoms; slowing of the heart rate; bluish colouration of the skin; facial flushing; circulatory collapse (failure of the blood circulation); nausea; vomiting; allergic skin rash

Very rare: cerebral ischaemia (decreased blood flow to the brain); methaemoglobinaemia (a disorder of the red blood cells); restlessness; difficulty breathing; skin rash

Not known: tongue swelling (due to an allergic reaction)

Reporting of side effects:

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed here.

You can also report side effects directly via the Yellow Card Scheme at: www.dorsapharma.com/ (ADR form)

By reporting side effects, you can help provide more information on the safety of this medicine.