Trocer Spray

Indications

Trocer sublingual spray is designed for the immediate relief of angina attacks and serves as a preventive measure for angina pectoris associated with coronary artery disease.
Always consult a registered healthcare professional before using this medication.

Description

Trocer is an organic nitrate that acts as a vasodilator, affecting both arteries and veins. This metered dose spray provides 400 mcg of Trocer per spray and contains 200 metered sprays for ease of use. The spray is designed to deliver medication in the form of tiny droplets directly under the tongue.

Pharmacology

The primary action of nitroglycerin is to relax vascular smooth muscle, leading to a vasodilatory effect on peripheral arteries and veins, with a more significant impact on the veins. By dilating post-capillary vessels, including larger veins, Trocer promotes blood pooling in the periphery, which decreases venous return to the heart, subsequently reducing left ventricular end-diastolic pressure (pre-load). Additionally, arteriolar relaxation lowers systemic vascular resistance and arterial pressure (after-load).

Dosage

At the first sign of an angina attack, administer 1 to 2 metered sprays under the tongue. Do not exceed 3 sprays within a 15-minute timeframe. If chest pain persists, seek medical attention promptly. Trocer can also be taken prophylactically 5 to 10 minutes before engaging in activities that may trigger an attack.
Always consult a registered healthcare professional before using this medication.

Administration

Important Instructions:

• Angina patients should always carry Trocer sublingual spray and consider keeping a second supply at home in an easily accessible location.
• This medication is intended solely for acute attacks and should not be used regularly.
• Avoid consuming alcoholic beverages after administration.
• Refrain from using sildenafil, vardenafil, or tadalafil while taking Trocer, as combining these medications can cause severe drops in blood pressure, potentially leading to loss of consciousness, heart attack, or even death.
• Store out of reach of children.

How to Use Trocer Spray:

1. If possible, sit down at the onset of angina.
2. Remove the plastic cap; do not shake the container.
3. Hold the container upright, placing your forefinger on top of the button.
4. Open your mouth and position the container as close to your mouth as possible, aiming it under your tongue.
5. Press the button gently to spray under your tongue.
6. Release the button and close your mouth. Avoid swallowing immediately and refrain from drinking water for 5 to 10 minutes after administration.
7. If a second spray is needed for relief, repeat steps 3, 4, 5, and 6. Replace the plastic cap afterward.

Always consult a registered healthcare professional before using this medication.

Interactions

Using alcohol with Trocer can lead to severe hypotension and fainting. Oral Trocer may enhance the effectiveness of dihydroergotamine. Caution is advised when using Trocer in conjunction with calcium channel blockers, phenothiazines, and tricyclic antidepressants, as this may result in orthostatic hypotension.

Contraindications

Trocer is contraindicated in individuals with hypersensitivity to nitrates or any ingredients in the formulation. It should not be used in cases of hypotension, hypovolemia, severe anemia, cerebral hemorrhage, brain trauma, mitral stenosis, or angina caused by hypertrophic obstructive cardiomyopathy. Avoid concurrent use with phosphodiesterase inhibitors for erectile dysfunction.

Side Effects

Common side effects associated with nitrates include headache, facial flushing, dizziness, nausea, vomiting, weakness, postural hypotension, and reflex tachycardia.

Pregnancy & Lactation

Pregnancy Category C: There are no well-controlled studies in pregnant women. Trocer should only be administered to pregnant women when clearly necessary. It is unclear if nitroglycerin is excreted in breast milk, so caution is advised when administering Trocer to nursing mothers.

Precautions & Warnings

When using Trocer during the early stages of an acute myocardial infarction, careful monitoring of hemodynamics and clinical status is crucial. Use with caution in patients with severe renal or hepatic impairment, hypothyroidism, malnutrition, or hypothermia.

Use in Special Populations

The safety and effectiveness of Trocer in pediatric patients have not been established.

Overdose Effects

Overdosing on nitrates may lead to severe hypotension, persistent headache, dizziness, palpitations, visual disturbances, flushing, nausea, vomiting (possibly with colic and bloody diarrhea), syncope (especially when upright), methemoglobinemia, and potentially fatal circulatory collapse.

Methemoglobinemia: Cases of clinically significant methemoglobinemia are rare at standard doses of organic nitrates, but it can occur with genetic predispositions even at conventional doses.

Treatment for Overdose: Keep the patient in a supine position and warm. Administer oxygen and artificial ventilation if necessary. If methemoglobinemia occurs, methylene blue (1% solution) may be administered intravenously at a dosage of 1-2 mg per kilogram of body weight. If a large amount of Trocer spray has been ingested, gastric lavage may be considered.

Therapeutic Class

Nitrates: Coronary vasodilators

Storage Conditions

Store Trocer in a cool, dry place away from light and heat. Ensure all medications are kept out of reach of children.