Angispan Tr 6.5 Mg Tablets

Angispan TR 6.5 Mg Tablets — Nitroglycerin (Glyceryl Trinitrate) Sustained-Release for Angina Prophylaxis

Angispan TR 6.5 Mg Tablets contain Glyceryl Trinitrate (Nitroglycerin / GTN) 6.5 mg in a transdermal release (TR) sustained-release oral tablet formulation, used for the prophylaxis (prevention) of angina pectoris. Angispan TR provides slow, controlled release of nitroglycerin to maintain sustained vasodilation throughout the day, reducing the frequency and severity of anginal episodes. Angispan TR is a prescription-only antianginal medicine and is not suitable for relief of acute angina attacks.

Composition

How Angispan TR Works — Mechanism of Action

Glyceryl Trinitrate (GTN) is an organic nitrate that undergoes enzymatic denitration in vascular smooth muscle cells, producing nitric oxide (NO):

• Nitric oxide release: GTN is metabolised by mitochondrial aldehyde dehydrogenase (ALDH2) and other enzymes in smooth muscle → generates NO → activates soluble guanylate cyclase → increases intracellular cyclic GMP (cGMP) → smooth muscle relaxation
• Venodilation (preload reduction): GTN is primarily a venodilator at standard doses → dilates systemic veins → reduces venous return to the heart (preload) → decreases left ventricular filling pressure and wall stress → reduces myocardial oxygen demand
• Arterial vasodilation at higher doses: Also dilates peripheral arteries and coronary arteries → reduces afterload and increases coronary blood flow in spasm-related angina
• Sustained release advantage: The TR (transdermal release) matrix delivers GTN gradually over 8–12 hours, avoiding the rapid peak-and-trough seen with sublingual GTN and providing sustained prophylactic coverage
• Nitrate-free interval: A daily nitrate-free interval of 10–12 hours (typically overnight) is essential to prevent nitrate tolerance — the loss of antianginal effect that occurs with continuous nitrate exposure

Clinical Indications

• Prophylaxis of stable angina pectoris: Prevention and reduction of frequency and severity of anginal episodes in patients with stable coronary artery disease
• Prophylaxis of vasospastic (Prinzmetal’s) angina: Prevention of coronary vasospasm in variant angina
• Adjunct in heart failure: Used in some heart failure regimens to reduce preload (under specialist guidance)

Angispan TR 6.5 Mg is not indicated for the acute relief of angina attacks. For acute attack relief, sublingual glyceryl trinitrate (sublingual tablet or spray) must be available at all times.

Dosage and Administration

• Standard dose: 6.5 mg twice daily — typically morning and early afternoon (e.g., 8 AM and 2 PM), allowing a nitrate-free interval from approximately 2 PM until 8 AM the following morning.
• ⚠️ Nitrate-free interval is essential: Taking both doses too late (e.g., morning and evening) eliminates the overnight nitrate-free period → nitrate tolerance develops → loss of antianginal effect. Follow prescriber instructions on timing precisely.
• Swallow whole: Do NOT crush, chew, or break sustained-release tablets.
• Can be taken with or without food.
• Keep sublingual GTN available: Always carry sublingual nitroglycerin tablets or spray for immediate relief of acute angina attacks while on Angispan TR maintenance therapy.

Special Populations

• Elderly: More susceptible to hypotension and dizziness. Start at lower doses (6.5 mg once daily) if appropriate. Rise slowly from sitting or lying position.
• Pregnancy: Limited safety data. Use only if clearly necessary. GTN has been used in obstetrics (tocolysis), but prophylactic oral use in pregnancy requires specialist evaluation.
• Breastfeeding: No specific data. Use with caution; monitor infant for excessive drowsiness.
• Renal impairment: No formal dose adjustment; monitor for excess hypotension.
• Hepatic impairment: GTN is extensively metabolised hepatically. Use with caution in severe hepatic impairment.

Precautions

• Hypotension: Nitroglycerin causes vasodilation → blood pressure drop. First dose may cause significant hypotension. Sit or lie down when taking the first dose. Avoid standing suddenly.
• Nitrate tolerance: Daily use without a nitrate-free interval leads to rapid tolerance — the drug becomes ineffective. Maintaining the nitrate-free interval (prescribed dosing schedule) is critical.
• Nitrate-free interval and nocturnal angina: The overnight nitrate-free interval can allow increased nocturnal angina. If nocturnal angina occurs, discuss schedule adjustment or addition of a second antianginal agent with your cardiologist.
• ⚠️ Sildenafil/tadalafil/vardenafil — absolute contraindication: Combining any nitrate (including GTN) with PDE5 inhibitors (Viagra, Cialis, Levitra and generics) causes severe, potentially life-threatening hypotension. This combination is absolutely contraindicated.
• Alcohol: Alcohol potentiates GTN’s hypotensive effect — avoid during treatment.
• Headache: Nitrate headache is very common, particularly at initiation. Usually improves after the first 1–2 weeks of treatment as tolerance to this side effect develops (without tolerance to the antianginal effect).
• Hypertrophic obstructive cardiomyopathy (HOCM): Avoid — venodilation worsens outflow tract obstruction.

Contraindications

• Hypersensitivity to glyceryl trinitrate, other organic nitrates, or nitrites
• Concurrent use of PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil) — absolute contraindication
• Concurrent use of soluble guanylate cyclase stimulators (riociguat)
• Severe hypotension (systolic BP <90 mmHg) or hypovolaemia
• Hypertrophic obstructive cardiomyopathy (HOCM)
• Constrictive pericarditis or cardiac tamponade
• Acute circulatory failure (shock)
• Closed-angle glaucoma (use with caution; raised intraocular pressure risk)
• Severe anaemia — impairs nitric oxide effect

Side Effects

Common (≥1/100): Headache (very common, often transient), flushing, dizziness, lightheadedness, hypotension, tachycardia (reflex), nausea.

Uncommon (≥1/1,000): Severe postural hypotension, bradycardia (paradoxical at high doses), syncope.

Rare: Methaemoglobinaemia (at very high doses or with prolonged use), severe allergic reactions.

Contact your doctor if headaches are severe and do not improve after 1–2 weeks, if you experience fainting or severe dizziness, or if angina worsens.

Drug Interactions

• PDE5 inhibitors (sildenafil, tadalafil, vardenafil): ABSOLUTE CONTRAINDICATION — severe, potentially fatal hypotension.
• Riociguat: Contraindicated — marked additive hypotension.
• Alcohol: Enhanced hypotension.
• Antihypertensives/vasodilators: Additive BP lowering — monitor and adjust doses.
• Heparin: Nitroglycerin may reduce heparin anticoagulant effect. Monitor coagulation.
• Ergotamine: Nitrate-induced vasodilation may antagonise ergot vasoconstriction; ergotamine may partially reverse GTN’s antianginal effect.

Storage Instructions

• Store at room temperature (below 30°C). Protect from heat, light, and moisture.
• Keep tightly capped in original packaging — nitroglycerin is volatile and can evaporate if exposed to air.
• Keep out of reach of children.
• Do not use past the expiry date.

Frequently Asked Questions

What is Angispan TR 6.5 used for?

Angispan TR 6.5 Mg is used to prevent angina attacks (chest pain from the heart) in patients with stable coronary artery disease. It works by releasing nitroglycerin slowly over several hours, relaxing blood vessels and reducing the heart’s workload. It is taken regularly to prevent angina from occurring — it is not for relieving an angina attack that has already started. For sudden attacks, sublingual nitroglycerin is needed.

Why is a nitrate-free interval important with Angispan TR?

If nitrates like nitroglycerin are present in the bloodstream continuously for more than 12 hours per day, the body quickly adapts and the drug stops working (nitrate tolerance). This is why Angispan TR is taken with a 10–12 hour nitrate-free period each day — usually overnight. Your prescriber will specify the dosing times to ensure this interval is maintained. If you miss it, do not make up for it by taking an extra dose; just continue the schedule.

Can I take Angispan TR if I use sildenafil (Viagra) for erectile dysfunction?

Absolutely not. Combining nitroglycerin (or any nitrate) with sildenafil, tadalafil (Cialis), vardenafil (Levitra), or similar drugs causes a severe, potentially life-threatening drop in blood pressure. If you use a PDE5 inhibitor, tell your doctor before starting Angispan TR. This interaction is an absolute contraindication regardless of the dose or timing of either drug.

Angispan TR gives me headaches — what should I do?

Headache is the most common side effect of nitroglycerin and usually indicates the drug is working (vasodilation affects the blood vessels in the head too). It is typically most severe in the first few days of treatment and often improves significantly after 1–2 weeks as tolerance to the headache side effect develops (without loss of the antianginal effect). Over-the-counter analgesics (paracetamol) may help. If headaches are severe, intolerable, or do not improve after 2 weeks, speak to your doctor about dose adjustment.

What do I do if I get angina while already taking Angispan TR?

Angispan TR reduces how often angina occurs but does not eliminate all attacks. If an attack occurs, use your sublingual nitroglycerin tablet or spray immediately as instructed. If the attack is not relieved after one or two doses of sublingual GTN over 10–15 minutes, or if it feels more severe than usual, seek emergency medical help immediately (call your emergency services) — this may indicate a heart attack.

References

1. NHS — Glyceryl Trinitrate (GTN). National Health Service, UK.
2. MedlinePlus — Nitroglycerin. U.S. National Library of Medicine.
3. FDA Prescribing Information — Nitroglycerin Extended-Release Capsules. U.S. Food and Drug Administration.
4. NHS — Angina: Overview and Treatment. National Health Service, UK.

Disclaimer: This product information is provided for general educational purposes only. Angispan TR 6.5 Mg is a prescription-only medicine. It must be used only as directed by a qualified healthcare professional. The combination of nitroglycerin with PDE5 inhibitors (sildenafil, tadalafil, vardenafil) is absolutely contraindicated and can be life-threatening. This content does not constitute medical advice. IndoGenMed.org supplies this product to licensed healthcare professionals and registered pharmacies only.