Repane

Introduction
Repane is used to treat and prevent heart-related chest pain (angina). Angina occurs when the heart muscle is not getting enough blood. This medicine works by relaxing and widening blood vessels so blood can flow more easily to the heart. It has a very short-lived effect. Repane is given as an injection under the supervision of a doctor with careful blood pressure monitoring. This is given as a continuous infusion into a vein and should not be stopped abruptly. It should not be mixed with any other medication of any kind. The most common side effect of Repane is a headache which may be severe. This can sometimes be helped by drinking plenty of fluids and avoiding alcohol. You may also experience lightheadedness, which could increase your risk of having a fall. There are other, rarer side effects, some of them serious. Ask your doctor and read the leaflet which comes with the medicine to make sure you are keeping safe. Do not use Repane if you are taking medicines to treat high blood pressure in your lungs (pulmonary hypertension), or erectile dysfunction; or if you have anaemia or glaucoma (increased pressure inside the eye). Always tell your doctor what other health conditions you have and what other medicines you are taking. It is best not to drink alcohol with this medicine as it increases some of the side effects. If you are affected by dizziness, avoid driving. If you are pregnant, thinking about becoming pregnant, or breastfeeding, ask your doctor before taking this medicine.

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Uses of Repane
Angina (heart-related chest pain)
Side effects of Repane
Common
Headache
How to use Repane
Your doctor or nurse will give you this medicine. Kindly do not self administer.
How Repane works
Repane is a nitrate. It works by relaxing the blood vessels which decreases the oxygen demand of the heart and reduces its workload, thereby preventing/treating attacks of angina (chest pain).
Quick Tips
It is given via a drip into a vein under the supervision of a doctor.
It may cause headaches which usually go away after a few days of continued treatment. Inform your doctor if it persists.
Repane may cause dizziness or sleepiness. Do not drive or do anything that requires concentration until you know how it affects you.
Do not consume alcohol while taking Repane as it may cause increased dizziness.
Stop taking medications (prescribed for erectile dysfunction) like sildenafil or tadalafil while on treatment with Repane as it may cause low blood pressure.
Brief Description
Indication
Chronic anal fissure
Administration
Gently insert the ointment into the anal canal using the finger. The finger with the ointment must be inserted to the first finger joint (approximately 1 cm) into the anus. Treatment may be continued until the pain goes away, or for up to a maximum 8 weeks.
Adult Dose
Rectal Anal fissure As 0.4% oint: Apply 1.5 mg 12 hrly up to 8 wk applied to the anal canal.
Contraindication
Do not use Glyceryl Trinitrate 0.4% ointment if the patients: are allergic to glyceryl trinitrate or to similar medicines suffer from low blood pressure suffer from heart or blood vessel disorders suffer from closed-angle glaucoma suffer from migraine or recurrent headaches suffer from increased intracranial pressure or high pressure within your skull suffer from anaemia are taking any of the following medicines: sildenafil citrate, tadalafil, vardenafil, medicines for angina or heart pain such as glyceryl trinitrate (GTN), isosorbide dinitrate, amyl or butyl nitrite, medicines for high blood pressure or depression (tricyclic anti-depressants), acetyl cysteine or alteplase

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Mode of Action
Glyceryl trinitrate acts on the enzyme nitric oxide stimulating guanylate cyclase in the vascular smooth muscle cells resulting in the relaxation of smooth muscles. It reduces venous return (preload) and facilitates subendocardial blood flow with redistribution into ischaemic areas. It relieves coronary vasospasm and dilates arterioles reducing afterload. It is useful for relief and prevention of anginal attacks.
Precaution
Take special care with Glyceryl Trinitrate 0.4% ointment if patient has: liver or kidney disease to be given heparin haemorrhoids (piles) and notice more bleeding than usual, severe headaches when using ointment, The ointment may lower blood pressure. Blood pressure is more likely to be lowered if drink alcohol whilst you are using ointment. Ointment is not indicated for patients under the age of 18 years.

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Side Effect
Headache is the most common side-effect when glyceryl trinitrate 0.4% ointment is used. Other side-effects include dizziness, faintness on standing, light-headedness, blurred vision and tiredness & nausea.

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Interaction
Enhances bioavailability of dihydroergotamine. Glyceryl trinitrate infusion may prolong pancuronium-induced neuromuscular blockade. May reduce the efficacy of heparin, alteplase and noradrenaline when used together. Efficacy of buccal and sublingual preparations may be reduced by drugs that can cause dry mouth due to decreased dissolution. Aspirin and other NSAIDs may reduce the therapeutic response to glyceryl trinitrate. Potentially Fatal: Orthostatic hypotension may be produced by combined use of calcium channel blockers, antihypertensives, phenothiazines and TCAs. Alcohol may cause severe hypotension and collapse.

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