What is better - "Validol" or "Nitroglycerin"? Comparison of drugs, indications for use, mechanism of action

In what cases is it best to use Validol, and in what cases is it best to use Nitroglycerin? As a rule, people do not always see the difference between these drugs. The effectiveness of Validol for heart disease is very doubtful; its pharmacological activity is weakly expressed, but there are practically no side effects. What is better - "Validol" or "Nitroglycerin" - for heart pain?

The second medicine is considered a more effective remedy for cardiovascular diseases. They differ from each other in activity, as well as in the range of indications and side effects.

When and what medicine is best to take

In what cases are Validol and Nitroglycerin taken? The first drug contains valerian ether and menthol. The medicine has a slight sedative effect and quickly dilates the coronary vessels.

What else does Validol help with? With it you can:

1. Eliminate minor pain in the heart. Most people who suffer from chronic cardiac diseases keep Validol in their medicine cabinet as a first aid medicine.
2. Calm down during hysteria and neurotic conditions.

It should be admitted that Validol is a very weak medicine; it is practically menthol lozenges.

What does Validol help with? This drug can eliminate pain near the heart, which is caused by vegetative-vascular dystonia, as well as neuroses, since it has a slight calming effect on the nervous system, and its vasodilating effect is too weak and occurs reflexively.

But “Nitroglycerin,” on the contrary, has proven itself well as a “reactive” medicine for patients who have developed acute ischemic heart pain. The medicine can eliminate unpleasant sensations in a short time and acts as a standard with which all modern means suitable for solving such problems are compared.

The therapeutic effect of nitroglycerin is that it sharply expands the capillaries, from which the heart itself is nourished. Thanks to this complex effect on the myocardium and surrounding vessels, it ensures durability and immediate therapeutic effect.

Instructions for use

Validol is taken sublingually. It must be consumed three times a day, regardless of meals. If the drug does not help cope with angina, the doctor replaces it with another drug. In case of an attack of neurosis, the tablet is dissolved once.

The medicine is sometimes prescribed to pregnant women in the first trimester. It helps to cope with toxicosis, flatulence, and gastrointestinal problems. The use of tablets should be supervised. It is necessary to monitor blood pressure and heart rate.

Risks of exceeding the dosage of Validol

During breastfeeding, the drug is not prescribed, since the effect is unknown - there is no data whether the drug substances pass into the milk of a nursing mother. Presumably the resulting effect is lower than the risk to the newborn.

Nitroglycerin is also taken sublingually. It is drunk when there is cardiac pain or before stress, which can cause angina. Take one or two tablets. It is necessary to take no more than one tablet at a time due to the high dosage of the drug.

In case of acute myocardial failure, it is allowed to take two tablets with an interval of 10 minutes. You must take the medicine under the supervision of a medical specialist.

Is it possible to use Nitroglycerin and Validol at the same time? Many doctors answer this question in the affirmative. Menthol, which Validol contains, alleviates some of the side effects of Nitroglycerin. It helps relieve nitrate migraines that the medication sometimes causes.

In addition, when there is pain in the heart, a person has a fear of death, which intensifies the pain and worsens the condition. It is in such cases that cardiologists recommend the simultaneous use of two medications - one will soothe, and the second will dilate the coronary arteries and improve blood flow to the heart.

The main thing with simultaneous use is compliance with dosages. If Nitroglycerin does not alleviate the condition, you should call an ambulance to avoid serious consequences.

How to take Validol

Validol tablets are recommended for patients to dissolve under the tongue. You can take the medication regardless of meals, three times a day. The duration of therapy is determined by a specialist individually for each patient.

If no positive pharmacological effect is observed within 10-15 minutes after resorption of the drug, the patient should consult a doctor to prescribe another medication. If you feel sick while riding in public transport, it is enough to take Validol once.

Use of Nitroglycerin

To prevent complications, you must use the drug as prescribed by your doctor. According to the instructions for use for Nitroglycerin tablets, the dosage is 1 piece.

It is kept in the oral cavity until completely dissolved, without swallowing. Nitroglycerin should be used immediately when the first symptoms of an angina attack occur or before intended physical exercise.

In case of stable angina pectoris, the effect may also occur with a lower dosage; in this situation, the remainder of the tablet that has not dissolved should be spat out. In most cases, improvement is noted within the first 3 minutes of taking Nitroglycerin. If the angina attack is not eliminated within five minutes, you need to take 1 more tablet.

If there is no pharmacological effect after using 2 Nitroglycerin tablets, you should immediately consult a doctor.

The spray is administered on or under the tongue, preferably in a sitting position, while holding your breath. After injection, the medicine is not swallowed immediately, but is held for a few seconds.

To avoid complications, Nitroglycerin must be taken as prescribed by a doctor. When the first symptoms of angina occur, 1-2 dosages of the spray are administered.

If necessary, another injection is likely to be administered, but no more than three doses within 15 minutes. If after using 3 doses within this time the condition does not improve, it is important to consult a doctor. The maximum single concentration is 3 doses of spray.

If the prescription for the use of “Nitroglycerin” is considered to be the prevention of angina pectoris, the medication is administered 1 dose ten minutes before possible exercise or stress. It is not necessary to shake the spray before use.

Nitrates in the treatment of patients with coronary heart disease: focus on isosorbide dinitrate

V.P. LUPANOV

, Doctor of Medical Sciences, Professor,
Research Institute of Clinical Cardiology named after.
A.L. Myasnikov Russian Cardiological Research and Production Complex of the Ministry of Health of Russia The article discusses the pharmacology of nitrates and their place in the complex therapy of coronary heart disease. The mechanisms of action of organic nitrates, especially the short-acting metered-dose spray isosorbide dinitrate (ID), are shown. Indications and contraindications for its use in various forms of IHD are analyzed.

The first drugs for the treatment of angina pectoris are nitrates - drugs from the group of nitrovasodilators. In 1879, Dr. W. Murrell published in the English journal Lancet the results of using a 1% alcohol solution of nitroglycerin to relieve angina attacks and to prevent them before physical activity [1]. Until the advent of b-blockers and calcium channel blockers (calcium antagonists), nitrates were the only representatives of antianginal drugs in the cardiologist’s arsenal. Despite the recent emergence of other effective drugs, nitrates still occupy a strong position in the treatment of patients with various clinical forms of coronary artery disease [2-4].

Fast-acting nitrates are still an unsurpassed means of relieving angina attacks. They are capable of providing a short-term, but quite pronounced and reliable effect [5-7]. The advantage of short-acting nitrates is the ability not only to prevent, but also to stop an already developed attack of angina. Recently, nitrates have been created in the form of aerosols containing either nitroglycerin or isosorbide dinitrate (Isoket-spray). The advantages of nitrate aerosols are dosage accuracy, good preservation of the drug, and ease of use.

The modern classification of nitrates is based on their pharmacological structure (organic nitrates, sydnonimines), duration of action (short-acting, moderate-acting, long-acting). Nitrates are available in various pharmacological forms (for intravenous, oral, transdermal, buccal use), which significantly expands the possibilities of their use both in the stable course of cardiovascular diseases and in emergency conditions.

Currently, three drugs in this group are used: nitroglycerin (NG), isosorbide dinitrate (ID) and isosorbide-5-mononitrate (ISM), which is a natural metabolite of ID.

Classification of organic nitrates [8]:

I. Short-acting organic nitrates for relieving angina attacks:

A. Nitroglycerin group: sublingual - NG tablets; nitroglycerin alcohol solution; Votchal drops (contain nitroglycerin and menthol); spray - Nitrospray, etc. B. Isosorbide dinitrate group: Isoket spray, etc. II. Short-acting organic nitrates: A. Isosorbide dinitrate group: tablets for sublingual use: Iso Mac 5 mg, etc.; tablets for oral administration: Nitrosorbide, Izodinit, etc. B. Isosorbide-5-mononitrate group: Mono Mac; Efox et al.

Mechanism of action and pharmacological effects

The antianginal effect of nitrates in ischemic heart disease plays a role primarily in the powerful dilating effect on the coronary vessels and hemodynamic changes that arise due to the relaxation of the entire system of peripheral vessels, including dilatation of capacitive veins. All this leads to a decrease in end-systolic and distolic pressure in the left ventricle (LV); Peripheral vascular resistance also decreases, which reduces LV afterload and its filling pressure, and also improves coronary blood flow in the subendocardial parts of the myocardium, which are most sensitive to ischemia. Nitrates cause vasodilation of arterioles and veins, which forms the basis for the symptomatic improvement of angina pectoris through the action of the active component of these drugs - nitric oxide (NO) - and by reducing preload [9, 10].

By duration of action

nitrates are divided into short-acting preparations (tablets, aerosols) (up to 1 hour); regular tablets of moderate prolonged action (from 1 to 6 hours) and special tablets, capsules, as well as patches with nitroglycerin of significant prolonged action (from 6 to 16 hours).

Pharmacokinetics

According to the route of entry into the body, nitrates are distinguished, absorbed through the mucous membrane of the mouth or in the gastrointestinal tract, for cutaneous and intravenous use ( Table 1

). By dosage forms: tablets, capsules, sprays, ointments, patches, solutions, etc. The low systemic bioavailability of NG when taken orally and at the same time good absorption through the skin and mucous membranes of NG capsules explain why in recent years depots have been used less and less. (or retard) NG tablets or capsules.

Indications for use and dosage
The clinical effectiveness of nitrates for angina pectoris largely depends on which drug, in what dose and dosage form is used, as well as on the regimen of its administration [11, 12]. There are organic nitrates for every clinical situation. The variety of dosage forms of nitrates makes it possible to select an individual treatment regimen in each specific case. This, on the one hand, allows you to make maximum use of the therapeutic properties of nitrates, and on the other, minimize the risk of side effects.

Table 2

the main forms of organic nitrates and recommended doses are shown.

For proper therapy with nitrates, it is necessary to know the exact diagnosis, document the presence of myocardial ischemia and angina as its manifestations, and establish the features of its occurrence [4, 7].
Short-acting nitrates for the relief of angina attacks

.
The main representative of this group of organic nitrates is nitroglycerin
. The drug has a myotropic antispasmodic effect and directly relaxes the muscles of the coronary vessels. The central inhibitory effect on sympathetic tone plays a certain role in this. The antianginal effect of NG is also due to the restructuring of hemodynamics associated with a general effect on blood vessels, relaxation of the smooth muscles of peripheral vessels, especially with the dilation of veins. Under the influence of NG, venous blood flow to the heart decreases, pressure in the right atrium and pulmonary artery system decreases, and peripheral vascular resistance decreases. The myocardium is also unloaded, its tension associated with resistance to blood ejection is reduced, and the myocardial oxygen demand and energy costs are reduced. Along with the weakening of ischemia, pain impulses from the ischemic focus gradually disappear and the pain syndrome stops. It is the ability of NG to stop angina attacks and prevent their occurrence that makes it a necessary part of the treatment of patients with coronary artery disease [11].

Isosorbide dinitrate (5 mg sublingual)

helps to interrupt an attack of angina for about 1 hour due to the fact that dinitrate must undergo transformation into mononitrate in the liver in order to exhibit its antianginal effect (after about 3-4 minutes, which is longer than when taking NG). After oral administration, hemodynamic and antianginal effects persist for several hours, which provides longer-term protection against angina pectoris than after taking NG sublingually.

Isosorbide dinitrate in the form of a spray (Isoket-spray)

for spraying onto the oral mucosa, onto the inner surface of the cheek, it is successfully used to relieve attacks of angina pectoris before physical or emotional stress, which usually causes angina pectoris [12]. To do this, you need to inject the aerosol into your mouth and hold your breath. The drug is available in 15 ml glass bottles containing 300 doses of 1.25 mg ID. If after the first injection a painful attack persists, then the injection can be repeated at an interval of 30 seconds once or twice while holding your breath. If a painful attack, typical of an attack of angina, persists, then you can repeat the injection of the aerosol at intervals of 30 seconds one or two more times while holding your breath.

Isosorbide dinitrate metered spray (Isoket)

. One dose of the drug solution contains 1.25 mg of ISDN. After spraying onto the oral mucosa, the effect appears within 1-3 minutes and lasts 90-120 minutes. Directions for use: bring Isoket-spray close to your mouth, holding the bottle vertically. Take a deep breath, exhale. Next, spray 1 dose (press the sprayer) into your mouth (this may cause a slight burning sensation on your tongue). After taking 1 dose, close your mouth and breathe through your nose for 30 seconds. Each time you press the spray nozzle, an equal amount of solution will be sprayed into tiny droplets. The drug easily penetrates the oral mucosa and enters the bloodstream in a matter of seconds. Isoket spray does not contain freon and is environmentally friendly. Another advantage is the transparency of the bottle, which allows you to notice the need for replacement in time.

Indications for the use of isosorbide dinitrate spray: relief of angina attacks, prevention of angina attacks, acute myocardial infarction, acute left ventricular failure.

To relieve an attack of angina pectoris or before physical or emotional stress that can cause an attack, you need to spray it into the mouth 1-3 times with an interval of 30 seconds between injections while holding your breath. A single dose of 3 injections to relieve an attack can be increased only on the strong recommendation of a doctor.

Pharmacodynamics of nitrates are presented in Table 3

.

Isoket spray in patients with angina pectoris can be taken prophylactically in cases where there is reason to expect an attack of angina pectoris, for example, during physical activity after eating, emotional stress, sexual activity, in case of going outside in cold weather, with angina pectoris that occurs with severe and moderate loads
Under tolerance (or addiction)

understand a decrease in the duration and severity of the effect of nitrates with regular use or the need to use a larger and larger dose to achieve the same effect while maintaining a sufficiently high concentration in the blood. The cause of tolerance to nitrates is considered to be: a decrease in the formation of nitric oxide (NO), acceleration of its inactivation due to increased activity of phosphodiesterases and increased formation of endothelin-1, which has a vasoconstrictor effect [13]. The classical hypothesis is associated with an intracellular decrease in the concentration of sulfhydride (SH) groups necessary for the implementation of the effects of NO.

Tolerance to nitrates depends on the prescribed dose and duration of treatment, it reduces the effectiveness of treatment and extends not only to the antianginal and hemodynamic effects, but also to the antiaggregation effect. Tolerance (addiction), a potential problem, can be prevented by changing the dosage and timing of administration, as well as by using slow-release drugs. Habituation is a reversible phenomenon. If nitrate is removed from the body, then sensitivity to it is quickly restored. It also turned out that if long-acting nitrates are not prescribed constantly, but in such a way that a period (7-10 hours) is created during the day when the drug is not in the body, then addiction to them does not develop or develops to a lesser extent than in those cases where they are taken continuously.

Many patients need the effect of nitrates only for a very limited period (this applies to patients with exertional angina of the 1st or 2nd functional class), when they give themselves increased stress (for example, going to or from work). It is for such patients that the aerosol form of nitrates is convenient.

Patients of functional class I (FC). Attacks of angina pectoris occur rarely and only under significant loads; as a rule, they do not require constant use of antianginal drugs. Nitrates are prescribed only intermittently in short-acting dosage forms that provide a quick and pronounced effect: tablets, capsules, NT and ID aerosols. Such forms should be taken 5-10 minutes before the expected physical activity, which usually causes an attack of angina.

For patients with stable angina pectoris class II (with infrequent attacks of angina and rare episodes of myocardial ischemia during the day), intermittent administration of nitrates before situations that can cause an attack of angina is possible. Along with short-acting forms, moderately prolonged-acting forms can be used.

For patients with more severe angina pectoris class III-IV (with frequent attacks of angina and episodes of silent myocardial ischemia during the daytime and also at night), nitrates should be prescribed regularly; in such patients one should strive to maintain the effect throughout the day. For this purpose, long-acting nitrates are convenient, giving an effect lasting 10-12 hours.

For class IV angina (when angina attacks can also occur at night), nitrates should be prescribed in such a way as to ensure an effect throughout the day. For this purpose, it is more convenient to prescribe long-acting nitrates 2 times a day in the morning and evening. Since angina attacks can also occur at night, nitrates should be prescribed to ensure their round-the-clock effect, and, as a rule, in combination with other antianginal drugs, primarily b-blockers.

The effect of nitrates on quality of life.

Quality of life is an integral indicator that includes the physical, social and psycho-emotional well-being of the patient and reflects his physical, social, cognitive and sexual abilities. The immediate task of improving the quality of life is to eliminate pain, change motor activity, psycho-emotional status, etc.; The long-term goal is to improve survival and reduce hospitalizations. In many patients with stable angina, due to periodic attacks leading to significant restrictions in daily life, the quality of life is reduced due to lack of energy, insufficient sleep, decreased physical activity, and the presence of mental disorders. The effect of nitrates on the prognosis of patients with coronary artery disease has not been clearly established.

In patients with angina after an MI, nitrates are most often used in combination with ACE inhibitors, which prevent the development of tolerance.

Nitrates are used for various forms of IHD:

Unstable angina (UA)

. The use of nitrates for NS is considered a generally accepted method of treatment. Intravenous infusion of NG in most cases effectively relieves and prevents the occurrence of angina at rest. In case of acute myocardial infarction or acute left ventricular failure, Isoket spray is taken only under the control of blood pressure, heart rate and medical supervision. At the beginning, 1-3 doses at intervals of 30 seconds, if there is no effect within 10 minutes, an additional dose (only under the supervision of a physician). Intravenous infusion of ID (isoket 0.1%) is more effective for NS than oral medications.

The use of nitrates in myocardial infarction

indicated for persistent signs of myocardial ischemia, as well as for congestive heart failure.

However, nitrates should not be prescribed when systolic blood pressure is <90 mmHg. Art. or when it decreases by more than 30 mm Hg. Art. from baseline, severe bradycardia (heart rate <50 beats/min) or tachycardia (heart rate >100-110 beats/min).

When prescribing drugs with a hemodynamic mechanism of action, in particular nitrates, in elderly patients, the following rules should be observed: start treatment with lower doses, carefully monitor undesirable effects and always consider changing the drug if it is poorly tolerated and insufficiently effective.

Contraindications to the use of nitrates

They can be divided into absolute: increased sensitivity to nitrates, severe arterial hypotension, hypovolemia, left ventricular failure with low end-diastolic pressure in the left ventricle, constrictive pericarditis, hemorrhagic stroke (up to 6 months); and relative: orthostatic arterial hypotension, hypertrophic cardiomyopathy with obstruction of the outflow tract, severe stenosis of the aorta or left atrioventricular orifice, increased intracranial pressure, encephalopathy, angle-closure glaucoma with high intraocular pressure, anemia.

Side effects of nitrates

Side effects that make it difficult to use nitrates (headache, palpitations, dizziness) caused by reflex sinus tachycardia also occur when taking short-acting nitrates. Hypotension is the most serious and headache the most common side effect of nitrates.

Headaches can be relieved with aspirin, but they can also lead to loss of adherence to treatment and even refusal to take nitrates.

During nitrate therapy, drinking alcohol may provoke or worsen hypotension.

Some patients may experience ineffective treatment with nitrates due to resistance to the action of nitric oxide or intolerance to nitrates.

A potential complication of taking long-acting nitrates is worsening endothelial dysfunction, and therefore the common practice of mandatory prescribing long-acting nitrates as first-line drugs in patients with exertional angina needs to be reconsidered [14].

Drug interactions of nitrates.

They are mainly pharmacodynamic in nature and involve increased vasodilation caused by calcium antagonists (nifedipine, amlodipine, felodipine, etc.) and ACE inhibitors.

Sapropterin is a cofactor for the synthesis of nitric oxide. It is recommended to be careful when using sapropterin-containing drugs simultaneously with all vasodilating agents whose action is associated with nitric oxide (NO), including NO donors - nitroglycerin, IDN, IMN, etc.

It should be noted that when nitrates are taken simultaneously with selective inhibitors of phosphodiesterase type 5 (PDE-5) (sildenafil, vardenafil, tadalafil, etc.), prescribed in connection with erectile dysfunction or for the treatment of pulmonary hypertension, uncontrolled arterial hypotension and the appearance of myocardial ischemia due to a sharp decrease in blood flow in stenotic coronary arteries. Sildenafil reduces blood pressure by approximately 8.4/5.5 mmHg. Art. and much more when taken together with nitrates. In case of inadvertent prescribing of a combination of a PDE5 inhibitor and a nitrate, an α-adrenergic agonist or even norepinephrine may be required in the emergency setting. Nitrates cannot be prescribed with α1-adrenergic receptor blockers (prazosin). In men with prostate diseases taking tamsulosin (a1A- and a1B-adrenergic receptor blocker), nitrates can be prescribed. Nitrates should be prescribed with caution to patients with a high degree of mitral regurgitation.

Conclusion

The presence of a pronounced antianginal and anti-ischemic effect allows the successful use of short-acting Izoket-spray nitrate for the prevention and relief of angina attacks in patients with stable coronary artery disease. When using Izoket-spray, patients' tolerance to physical activity significantly increases, the number of angina attacks decreases, and the quality of life improves.

The presence of angina attacks in the absence of contraindications is an indication for the prescription of nitrates. Unfortunately, nitrates used to treat angina pectoris are not able to completely cure the disease, but they change the physiological situation in the myocardium and significantly facilitate the work of the diseased heart.

Isoket spray has been successfully used to treat various forms of coronary artery disease. It has a pronounced antianginal effect if prescribed in an adequate dose, and improves the quality of life of patients in whom angina pectoris significantly limits physical activity.

Nitrates in the form of aerosols can be used as the main antianginal agents in patients with mild angina (FC I-II). The use of Isoket-spray in aerosol form allows you to accelerate the onset of action of the active substance and reduce the time to relieve an attack compared to tablets for sublingual administration.

Nitrates only have the ability to prevent and stop attacks of angina and do not affect the course of IHD itself (the effect of nitrates on the prognosis of patients with IHD has not been proven). Therefore, patients with IHD, in addition to nitrates, need to take a number of other drugs: b-blockers, statins, aspirin, IHD inhibitors.

Literature

1. Murrell W. Nitro-glycerine as a remedy for angina pectoris.
Lancet, 1879; 1: 80-81. 2. Thadani U, Lipicky RJ. Short and long-acting oral nitrates for stable angina pectoris. Cardiovasc Drugs Ther, 1994, 8(4): 611-623. 3. Abrams J. How to use nitrates. Cardiovasc Drugs Ther, 2002, 16(6): 511-514. 4. Aronov D.M., Lupanov V.P. Differentiated use of nitrates in coronary heart disease depending on the form and severity of the disease. Cardiology, 2006, 1: 74-82. 5. Kimch A, Amsterdam E et al. Increased exercise tolerance after nitroglycerin oral spray: a new and after therapeutic modality in angina pectoris. Circulation, 1983, 67: 124-127. 6. Olbinskaya L.I., Sizova Zh.M., Ushakova A.V. Comparative effectiveness, safety, cardiohemodynamic effects of isosorbide dinitrate aerosol and sublingual nitroglycerin tablets. Ter. archive, 1998, 3: 69-72. 7. Metelitsa V.I. Handbook of clinical pharmacology of cardiovascular drugs. M., Medical Information Agency LLC, 2005: 198-203. 8. Kryzhanovsky S.A., Vititnova M.B. Medicines for the treatment of coronary heart disease (basic, clinical and evidence-based pharmacology). Lecture 2, part 1. Organic nitrates and their place in the pharmacotherapy of coronary heart disease. Therapist, 2011, 3: 38-54. 9. Munzel T, Steven S, Daiber A. Organic nitrates: update on mechanisms underlying vasodilation, tolerance and endothelial dysfunction. Vascul Pharmacol, 2014, 63(3): 105-113. 10. Lupanov V.P. Nitrates. Guide to cardiology in four volumes. Ed. acad. Chazova E.I. Ed. "Practice", 2014, 4: 688-703. 11. Mazur N.A. The role of nitrates in the treatment of cardiac patients in accordance with the principles of evidence-based medicine and recommendations for their practical use. Cardiology, 2005, 8: 92-96. 12. Silber S. Nitrates: why and how should they be used today? Current status of the clinical usefulness of nitroglycerin, isosorbide dinitrate, isosorbide -5-mononitrate. Eur J Clin Pharmacol, 1990, 38(1): 35-51. 13. Thadani U. Challenges with nitrate therapy and nitrate tolerance: prevalence, prevention, and clinical relevance journal. Amer J Cardiovasc Drugs, 2014, 14(4):287-301. 14. Lupanov V.P. Nitrates. In the book:. Rational pharmacotherapy of cardiovascular diseases: a guide for practitioners. Compendium Under the general ed. E.I. Chazova, Yu.A. Karpova. 2nd ed. corr. and additional M.: Litterra, 2015, chapter 10: 106-122. Source:
Medical Council, No. 8, 2015

Is it possible to take Validol and Nitroglycerin together?

Yes, this is allowed. Although Validol dilates capillaries and has a sedative effect on the body, it is useless for angina pectoris. But it is still not recommended to immediately abandon its use. Since during an angina attack the patient not only experiences chest pain, but also fear of death.

Validol will help eliminate this fear. Nitroglycerin can quickly neutralize a heart attack, but it provokes nausea and headaches, which can also be removed with Validol. Therefore, in this situation, it is best to use these medications at the same time.

Properties and mechanism of action of Nitroglycerin

Nitroglycerin is one of the most effective remedies for angina attacks. When dissolved in the sublingual area, it acts after a few minutes. It has an analgesic effect in angina pectoris and affects blood vessels, dilating them. The duration of exposure is a little longer than an hour.

By expanding the walls of the coronary vessels, it promotes a rush of blood to the heart, improves its nutrition and oxygen saturation, which makes it possible to stop an attack. In small doses and with long-term use, it steadily expands the lumen in blood vessels.

What are the differences between medications

What is the difference between Validol and Nitroglycerin? Both medications have been known to everyone for a long time.

But despite this, there will always be those people for whom the question of what is the difference between “Validol” and “Nitroglycerin” puts them in a difficult position. And the difference is significant, starting from the purpose, dose, ending with adverse reactions.

When are medications prescribed?

When to take Nitroglycerin and when to take Validol? Indications for use vary. Here are the situations in which it is necessary to use Validol:

1. Stable mild form of angina (attacks of sudden chest pain that develop as a result of an acute lack of blood supply to the heart muscle).
2. Painful sensations of various etiologies.
3. Insomnia (a pathological condition in which the process of onset and maintenance of sleep is disrupted).
4. Neurotic disorders (a collective name for a group of functional psychogenic reversible disorders that tend to be protracted).
5. Kinetosis (motion sickness disease develops in people when riding on ships, cars, planes, and less often on a train).
6. Migraine (the primary form of headache, the symptoms of which are periodic attacks of moderate to severe headaches).
7. Hysterical disorder (personality disorder characterized by an inexhaustible need for attention, unstable self-esteem, overestimation of the importance of gender, feigned behavior).
8. Panic attack (an anxiety attack accompanied by unreasonable fear, combined with various symptoms).
9. Nausea.

What is better - "Validol" or "Nitroglycerin"? The second medication is considered an active ingredient for many nitro drugs:

1. For acute angina pain, it can be used in the form of sublingual tablets, as well as a spray or intravenously.
2. In acute myocardial infarction (a focus of ischemic necrosis of the myocardium, which occurs after an acute violation of the coronary circulation).
3. Myocardial insufficiency (impaired functioning of the heart muscle).
4. Hypertensive crisis (a serious illness that is triggered by an increase in blood pressure, manifested clinically and requiring an immediate decrease in blood pressure to limit target organ damage).

Which is better, “Validol” or “Nitroglycerin”, interests many people.

Adverse reactions of Validol

The drug does not contain monosaccharides, so it can be given to people who suffer from diabetes. Patients, as a rule, tolerate it well, sometimes there are negative effects:

1. Angioedema (violation of vascular tone and blood circulation in a separate place or in the entire circulatory system at once).
2. Dizziness.
3. Nettle rash.
4. Epigastric pain.
5. Vomit.

All of the above symptoms do not require treatment and go away on their own in a short time.

Side effects

Validol tablets do not contain monosaccharides, so they can be used by patients with diabetes. Although the medicine is harmless, some side effects may occur:

• vertigo syndrome;
• angioedema;
• vomit;
• pain syndrome in the epigastrium;
• hives.

Side effects of Validol

All these phenomena do not cause great concern. After a short period they pass by themselves.

Nitroglycerin has the following side effects:

• vertigo;
• weakness;
• nausea;
• vomit;
• allergic skin reaction;
• severe drop in blood pressure with increased angina symptoms;
• fainting;
• cardiac arrhythmia.

After first use or increasing dosage, people with heart disease may experience persistent angina.

Negative effects of Nitroglycerin

But “Nitroglycerin” has more side effects, but it also acts somewhat stronger than “Validol”. Negative effects that the drug can provoke:

1. Dizziness.
2. Redness.
3. Vomiting.
4. Cardiac arrhythmia (a pathological condition in which disturbances in the frequency, rhythm and sequence of excitation and contraction of the heart occur).
5. Nausea.
6. Syncope (an attack of short-term loss of consciousness caused by a temporary disruption of cerebral blood flow.).
7. Skin allergic manifestations.
8. A sharp drop in blood pressure with increased signs of angina.

These negative phenomena are provoked by a sharp expansion of the cerebral capillaries, which causes a lot of blood to flow to the brain. But the effect of Nitroglycerin is short-lived, and when it ends, side reactions also disappear.

Which remedy is more effective?

Validol is a drug with questionable effectiveness, unexpressed activity and no side effects. Helps only with non-dangerous manifestations of angina pectoris. In difficult situations, his effectiveness is lacking. Recently, many doctors in developed countries compare Validol with an ordinary mint candy, which in no way can help a person with a heart attack.

Nitroglycerin copes with intense pain in the heart of an ischemic nature. It can quickly and effectively relieve an attack of angina pectoris and alleviate other cardiovascular problems.

Contraindications to Nitroglycerin

The use of the drug is prohibited for the following pathological conditions, which include:

1. Arterial hypotension (a long-term condition of the body characterized by low blood pressure and various autonomic disorders: decreased body temperature, sweating of the feet and palms, pallor).
2. Constrictive pericarditis (fibrous thickening of the pericardial layers and obliteration of the pericardial cavity, leading to compression of the heart and impaired diastolic filling of the ventricles).
3. Compression of the heart.
4. Hypertrophic cardiomyopathy (primary isolated myocardial damage, characterized by hypertrophy of the ventricles (usually the left) with a reduced or normal volume of their cavities).
5. Increased intracranial pressure.
6. Angle-closure glaucoma with increased intraocular pressure (a pathological process that leads to injury to the optic nerve).

Before starting Nitroglycerin therapy, it is important to ensure that there are no contraindications.

Comparison of "Validol" and "Nitroglycerin" during pregnancy and breastfeeding

The drug "Validol" is sometimes recommended to women during an interesting situation in the first three months to alleviate early toxicosis. According to the responses of expectant mothers, the tablets are really good at neutralizing nausea, as well as increased salivation and preventing increased gas formation.

The use of medication in pregnant women should only be done under the supervision of a doctor, and it is important to monitor pulse and blood pressure. During lactation, you can use Validol, but only under strict medical indications.

Nitroglycerin can be used during pregnancy. But this is only in a situation where there will be more benefit from it for the unborn child than harm. While using it, you must stop breastfeeding. Therefore, it will not work to say which is better - “Validol” or “Nitroglycerin” - during pregnancy.