Yes

Vasodilator

Possibly effective for the prophylactic long-term management of angina pectoris. Note: Not indicated to abort acute anginal episodes.

C

Hypersensitivity to pentaerythritol tetranitrate or other nitrates; severe anemia; angle-closure glaucoma; postural hypotension; cerebral hemorrhage; head trauma

Use with caution in patients with hypotension, hypovolemia, or increased intracranial pressure.

>10%:

Cardiovascular: Flushing, postural hypotension

Central nervous system: Headache, lightheadedness, dizziness

Neuromuscular & skeletal: Weakness

1% to 10%: Dermatologic: Drug rash, exfoliative dermatitis

<1% (Limited to important or life-threatening symptoms): Nausea, vomiting, methemoglobinemia (overdose)

Alcohol (increased hypotension)

Aspirin (increases serum nitrate concentration)

Calcium channel blockers (increases hypotension)

Heparin's anticoagulant effect may be antagonized

Sildenafil: May cause severe hypotension; use is contraindicated.

Stimulation of intracellular cyclic-GMP results in vascular smooth muscle relaxation of both arterial and venous vasculature. Increased venous pooling decreases left ventricular pressure (preload) and arterial dilatation decreases arterial resistance (afterload). Therefore, this reduces cardiac oxygen demand by decreasing left ventricular pressure and systemic vascular resistance by dilating arteries. Additionally, coronary artery dilation improves collateral flow to ischemic regions; esophageal smooth muscle is relaxed via the same mechanism.

Onset of hemodynamic effect: Oral: Within 20-60 minutes

Duration: 4-5 hours, or up to 12 hours with the sustained release formulations

Serum half-life: 10 minutes

Adults: Oral: 10-20 mg 4 times/day up to 40 mg 4 times/day before or after meals and at bedtime; sustained release preparation 80 mg twice daily; use lowest recommended doses in elderly initially; titrations up to 240 mg/day are tolerated, however, headache may occur with increasing doses (reduce dose for a few days; if headache returns or is persistent, an analgesic can be used to treat symptoms)

Should be administered with glass of water on an empty stomach

Concomitant use of sildenafil (Viagra®) may precipitate acute hypotension, myocardial infarction, or death. Nitrates used in right ventricular infarction may induce acute hypotension. Nitrate use in severe pericardial effusion may reduce cardiac filling pressure and precipitate cardiac tamponade.

May cause drowsiness

None reported

No information available to require special precautions

No effects or complications reported

Keep tablets in original tightly closed container; do not chew or crush sustained release product

Do not crush sustained release drug product

Monitor blood pressure reduction for maximal effect and orthostatic hypotension

Capsule: sustained release: 15 mg, 30 mg

Tablet: 10 mg, 20 mg, 40 mg

Sustained release: 80 mg