Pentaerythrityl tetranitrate

Oral
Angina pectoris

Should be taken on an empty stomach. Take before meals & at bedtime.

Severe hypotension, heart failure, marked anaemia, hypertrophic obstructive cardiomyopathy, patients with cerebral haemorrhage or head trauma, low cardiac output secondary to hypovolaemia, inferior MI with right ventricular involvement, raised intracranial pressure.

Severe hepatic or renal impairment, hypothyroidism, malnutrition, hypothermia. Cerebrovascular disease, lung disease or cor pulmonale. Pregnancy, lactation, glaucoma, mitral valve prolapse, cardiac tamponade, syncope.

Flushing of the face, dizziness, tachycardia, throbbing headache and tolerance. Large dose can cause vomiting, restlessness, hypotension, syncope, rarely cyanosis and methaemoglobinaemia, impaired respiration, bradycardia. Nausea, urinary and faecal incontinence, abdominal pain, apprehension, weakness, vertigo.
Potentially Fatal: Paradoxical bradycardia, impaired respiration and collapse.

Treat syncope and hypotension by keeping patient in recumbent position with head lowered. Severe poisoning: oxygen admin with assisted respiration, plasma expanders or electrolyte solutions to maintain circulation. IV methylthioninium to treat methaemoglobinaemia. Severe poisoning with tablets: stomach lavage (charcoal if ingested within 1 hr).

Enhances bioavailability of dihydroergotamine. Hypotensive effects may be enhanced by alcohol and vasodilators such as ACE inhibitors.
Potentially Fatal: Orthostatic hypotension may be produced by combined use of Ca channel blockers, antihypertensives, phenothiazines and tricyclic antidepressants. Alcohol may cause severe hypotension and collapse.

False-positive decrease in serum cholesterol.

Description:
Mechanism of Action: Pentaerythrityl tetranitrate exerts a vasodilating effect through release of nitric oxide causing stimulation of guanylate cyclase in the vascular smooth muscle cells thus inducing relaxation. It also has a coronary vasodilator effect which improves regional coronary blood flow to ischaemic areas resulting in improved O2 supply to the myocardium.

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