Start of angina attack or immediately before stress known to trigger an attack 0.4-1.2 mg (1-3 puffs). Acute heart failure, acute heart attack 0.4-1.2 mg (1-3 puffs), w/ monitoring of blood circulation (systolic BP >100 mmHg). May repeat same dose if no response after 10 mins. Preventive measure before coronary angiography 0.4-0.8 mg (1-2 puffs).
Hypersensitivity to glyceryl trinitrate, other nitrate compounds, peppermint oil. Acute circulatory failure; marked hypotension; cardiogenic shock, unless there are appropriate measures in place to ensure a sufficiently high left-ventricular end diastolic pressure; hypertrophic, obstructive cardiomyopathy; disorders associated w/ increased pressure inside the skull (eg, head injuries, bleeding on the brain); severe anaemia. Concomitant use w/ certain medicines for erectile dysfunction or pulmonary arterial HTN.
Constrictive pericarditis or pericardial tamponade. Low filling pressure eg, in acute heart attack, left-sided heart failure; reduction in systolic BP <90 mmHg should be avoided. Aortic &/or severe mitral valve stenosis. Prone to orthostatic hypotension. Disorder affecting blood flow through the brain. Early stages of glaucoma. Left ventricular hypertrophy combined w/ aortic valve stenosis. May impair ability to drive or operate machinery. Pregnancy & lactation.
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