Nitroglycerin Slocaps

DESCRIPTION

DESCRIPTION SECTION

Nitroglycerin is 1,2,3-propanetriol trinitrate, an organic nitrate whose structural formula is: and whose molecular weight is 227.09. The organic nitrates are vasodilators, active on both arteries and veins. Each NITROGLYCERIN SLOCAP®, for oral administration, contains 2.5 mg, 6.5 mg, or 9 mg of nitroglycerin. Each capsule also contains the following inactive ingredients: gelatin, lactose, pharmaceutical glaze, corn starch, sucrose, talc and other ingredients. In addition, the 2.5 mg capsule contains FD&C Blue #1, FD&C Red #3 and D&C Yellow #10; the 6.5 mg capsule contains FD&C Blue #1, D&C Red #33, FD&C Yellow #6, and D&C Yellow #10; and the 9 mg capsule contains FD&C Green #3, FD&C Yellow #6, D&C Yellow #10 and titanium dioxide.

CLINICAL PHARMACOLOGY

CLINICAL PHARMACOLOGY SECTION

The principal pharmacological action of nitroglycerin is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins, especially the latter. Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Dilatation of the coronary arteries also occurs. The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. Dosing regimens for most chronically used drugs are designed to provide plasma concentrations that are continuously greater than a minimally effective concentration. This strategy is nappropriate for organic nitrates. Several well-controlled clinical trials have used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates. In the large majority of these trials, active agents were indistinguishable from placebo after 24 hours (or less) of continuous therapy. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed. Only after nitrates had been absent from the body for several hours was their antianginal efficacy restored.

INDICATIONS AND USAGE

INDICATIONS & USAGE SECTION

Nitroglycerin Slocaps® (Nitroglycerin) are indicated for the prevention of angina pectoris due to coronary artery disease. The onset of action of oral nitroglycerin is not sufficiently rapid for this product to be useful in aborting an acute anginal episode.

CONTRAINDICATIONS

CONTRAINDICATIONS SECTION

Allergic reactions to organic nitrates are extremely rare, but they do occur. Nitroglycerin is contraindicated in patients who are allergic to it.

WARNINGS

WARNINGS SECTION

The benefits of oral nitroglycerin in patients with acute myocardial infarction or congestive heart failure have not been established. If one elects to use nitroglycerin in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of hypotension and tachycardia. Because the effects of sustained release capsules are so difficult to terminate rapidly, sustained release capsules are not recommended in these settings.

PRECAUTIONS

PRECAUTIONS SECTION

ADVERSE REACTIONS

ADVERSE REACTIONS SECTION

Adverse reactions to nitroglycerin are generally dose-related, and almost all of these reactions are the result of nitroglycerin’s activity as a vasodilator. Headache, which may be severe, is the most commonly reported side effect. Headache may be recurrent with each daily dose, especially at higher doses. Transient episodes of lightheadedness, occasionally related to blood pressure changes, may also occur. Hypotension occurs infrequently, but in some patients it may be severe enough to warrant discontinuation of therapy. Syncope, crescendo angina, and rebound hypertension have been reported but are uncommon. Allergic reactions to nitroglycerin are also uncommon, and the great majority of those reported have been cases of contact dermatitis or fixed drug eruptions in patients receiving nitroglycerin in ointments or patches. There have been a few reports of genuine anaphylactoid reactions, and these reactions can probably occur in patients receiving nitroglycerin by any route. Extremely rarely, ordinary doses of organic nitrates have caused methemoglobinemia in normal-seeming patients; for further discussion of its diagnosis and treatment see OVERDOSAGE . Data are not available to allow estimation of the frequency of adverse reactions during treatment with Nitroglycerin Slocaps® (Nitroglycerin).

OVERDOSAGE

DRUG ABUSE AND DEPENDENCE SECTION

DOSAGE AND ADMINISTRATION

DOSAGE & ADMINISTRATION SECTION

As noted above ( CLINICAL PHARMACOLOGY ), careful studies with other formulations of nitroglycerin have shown that maintenance of continuous 24- hour plasma levels of nitroglycerin results in tolerance (i.e., loss of clinical response). Every dosing regimen for Nitroglycerin Slocaps® should provide a daily nitrate-free interval to avoid the development of this tolerance. The minimum necessary length of such an interval has not been defined, but studies with other nitroglycerin formulations have shown that 10-12 hours is sufficient. Large controlled studies with other formulations of nitroglycerin show that no dosing regimen with Nitroglycerin Slocaps® should be expected to provide more than about 12 hours of continuous antianginal efficacy per day. The pharmacokinetics of nitroglycerin capsules, and the clinical effects of multiple-dose regimens, have not been well studied. In clinical trials, the initial regimen of nitroglycerin capsules has been 2.5 to 6.5 mg three to four times a day, with subsequent upward dose adjustment guided by symptoms and side effects. In one trial, 5 of the 18 subjects were titrated up to a dose of 26 mg four times a day.

HOW SUPPLIED

HOW SUPPLIED SECTION

Nitroglycerin Slocaps® capsules are available in bottles of 60 and are supplied as: Nitroglycerin Slocaps® 2.5 mg NDC 21695-635 amethyst and clear capsule with white pellets; imprinted E 5174. Nitroglycerin Slocaps® 6.5 mg NDC 21695-635-60 blue and yellow capsule with white pellets; imprinted E 1235.

Principal Display Panel

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

Principal Display Panel

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL