Health Centres - Angitak spray (isosorbide dinitrate)
How does it work?
Angitak spray contains the active ingredient isosorbide dinitrate, which is a type of medicine called a nitrate. It is used to help the heart work more easily.
Isosorbide dinitrate works by being converted in the body to a chemical called nitric oxide. This chemical is made naturally by the body and has the effect of making the veins and arteries relax and widen (dilate). When the blood vessels dilate in this way there is more space inside them and hence less resistance. This makes it easier for the heart to pump blood around the body.
Widening the veins also decreases the volume of blood that returns to the heart with each heartbeat. This makes it easier for the heart to pump that blood out again.
As a result of both these actions, the heart does not need as much energy to pump the blood around the body and therefore needs less oxygen.
Isosorbide dinitrate also widens the arteries within the heart itself, which increases the blood and oxygen supply to the heart muscle.
The pain of angina is caused by too little oxygen reaching the heart when its workload increases, such as during exercise. Isosorbide dinitrate improves the oxygen supply to the heart, as well as decreasing the amount of oxygen that the heart needs by making it easier for the heart to pump blood around the body. It can therefore be used to treat angina.
Angitak spray is sprayed under the tongue. This area of the mouth has a large supply of blood vessels that allows the medicine to be rapidly absorbed. Isosorbide dinitrate taken in this way is used to give rapid relief from the pain of an angina attack. The spray can also be used to prevent an anticipated attack, for example before exercise or physical effort, emotional stress or exposure to cold.
Isosorbide dinitrate is also available as long-acting tablets that are taken regularly each day to help prevent angina attacks. See the factsheets linked at the end of this article for more information.
Warning!
- Follow the instructions you receive with this medicine. Angitak spray should be sprayed under the tongue, and the mouth closed after each dose. Do not inhale the spray.
- This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance. If you do feel dizzy after taking a dose, sit or lie down until the symptoms pass.
- Drinking alcohol may enhance some of the side effects of this medicine, such as feeling faint or dizzy.
Use with caution in
- Severely decreased liver function.
- People who have recently had a heart attack.
- Underactive thyroid gland .
- People with low levels of oxygen in their blood, eg due to lung disease.
- Dangerously low body temperature (hypothermia).
- Malnutrition.
Not to be used in
- Allergy to nitrates.
- Low blood pressure (hypotension).
- Low volume of circulating blood (hypovolaemia).
- Inflammation of the sac surrounding the heart that stops the heart from beating properly (constrictive pericarditis).
- Fluid in the sac surrounding the heart that prevents the heart beating properly (cardiac tamponade).
- Narrowing of the main artery coming from the heart (aortic stenosis).
-
Narrowing of one of the valves in the heart.
- Heart disease in which the muscle of the heart grows abnormally (hypertrophic obstructive cardiomyopathy).
- Head injury.
- Bleeding in the brain (cerebral haemorrhage).
- Severe anaemia.
-
Closed angle glaucoma.
- This medicine is not recommended for use in children.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The safety of this medicine for use during pregnancy has not been established. It should only be used during pregnancy if the benefits to the mother outweigh any risks to the developing baby. Seek medical advice from your doctor.
- It is not known if this medicine passes into breast milk. It should only be used by breastfeeding mothers if the benefits to the mother outweigh any risks to the nursing infant. Seek medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Headache.
- Dizziness.
- Weakness.
- Nausea.
- Flushing.
- Burning or stinging sensation in the mouth.
- A drop in blood pressure that occurs when moving from a lying down or sitting position to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
- Increased heart rate (tachycardia).
- Decreased heart rate (bradycardia).
- Allergic skin reactions.
- Fainting.
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
The medicines for erectile dysfunction (impotence) listed below must not be used by people taking isosorbide dinitrate, because the combination can produce a severe drop in blood pressure resulting in dizziness, fainting, or even a heart attack:
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra).
If this medicine is taken in combination with other medicines that reduce blood pressure, either as a treatment for high blood pressure (antihypertensives), or as a side effect, there may be an enhanced blood pressure lowering effect. This might make some people feel dizzy. If you do feel dizzy, you should lie down until the symptoms pass. Other medicines that can reduce blood pressure include the following:
- ACE inhibitors, eg enalapril, captopril
- alpha blockers, eg alfuzosin, doxazosin
- alprostadil
- anaesthetics
- angiotensin II receptor antagonists, eg losartan
- certain antipsychotic medicines, eg chlorpromazine
- baclofen
- benzodiazepines, eg temazepam
- beta-blockers, eg propranolol
- calcium channel blockers, eg diltiazem, verapamil, nifedipine
- clonidine
- diuretics, eg furosemide
- hydralazine
- levodopa
- MAOI antidepressants, eg phenelzine
- methyldopa
- minoxidil
- moxisylyte
- moxonidine
- other nitrates, eg glyceryl trinitrate, amyl nitrate (poppers)
- tricyclic antidepressants, eg amitriptyline.
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