Nitroglycerine

Also indexed as: Coro-Nitro Pump Spray®, Deponit®, Glyceryl Trinitrate, Glytrin Spray®, GTN 300 mcg, Minitran®, Nitrek®, Nitro-Bid®, Nitro-Dur®, Nitro-Time®, Nitrodisc®, Nitrogard®, Nitroglyn®, Nitrolingual Pumpspray®, Nitrolingual®, Nitrol®, Nitromin®, Nitrong SR®, Nitrostat®, Percutol®, Suscard®, Sustac®, Transderm-Nitro®, Transiderm-Nitro®, Tridil®, Trinipatch®

Nitroglycerine dilates blood vessels by relaxing the smooth muscles surrounding them, increasing blood flow. Nitroglycerine is used to treat or prevent chest pain in people with angina pectoris and to treat instances of congestive heart failure.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

May be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.	N-acetyl cysteine* Vitamin C
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	N-acetyl cysteine*
Depletion or interference	None known
Side effect reduction/prevention	None known
Reduced drug absorption/bioavailability	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

N-acetyl cysteine (NAC)
Continuous nitroglycerine use leads to development of nitroglycerine tolerance and loss of effectiveness. Intravenous (iv) N-acetyl cysteine (NAC), during short-term studies of people receiving continuous nitroglycerine, was reported to reverse nitroglycerine tolerance.¹ ² In a double-blind study of patients with unstable angina, transdermal nitroglycerine plus oral NAC (600 mg three times per day) was associated with fewer failures of medical treatment than placebo, NAC, or nitroglycerine alone. However, when combined with nitroglycerine use, NAC has led to intolerable headaches.³ ⁴ In two double-blind, randomised trials of angina patients treated with transdermal nitroglycerine, oral NAC 200 mg or 400 mg three times per day failed to prevent nitroglycerine tolerance.⁵ ⁶

Vitamin C
Vitamin C may help maintain the blood vessel dilation response to nitroglycerine. A double-blind study found that individuals taking 2 grams of vitamin C three times per day did not tend to develop nitroglycerine tolerance over time compared to those taking placebo.⁷ In another controlled clinical trial, similar protection was achieved with 500 mg three times daily.⁸

People using long-acting nitroglycerine can avoid tolerance with a ten- to twelve-hour hour nitroglycerine-free period every day. People taking long-acting nitroglycerine should ask their prescribing doctor or chemist about preventing nitroglycerine tolerance.

Interactions with Foods and Other Compounds

Alcohol
Alcohol, when consumed during nitroglycerine therapy, may cause low blood pressure and circulatory collapse in extreme cases.⁹ People using nitroglycerine should avoid alcohol.

References
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1. Ghio S, de Servi S, Perotti R, et al. Different susceptibility to the development of nitroglycerin tolerance in the arterial and venous circulation in humans—Effects of N-acetylcysteine administration. Circulation 1992;86:798–802.

2. May DC, Popma JJ, Black WH, et al. In vivo induction and reversal of nitroglycerin tolerance in human coronary arteries. N Engl J Med 1987;317:805–9.

3. Iversen HK. N-acetylcysteine enhances nitroglycerin-induced headache and cranial artery response. Clin Pharmacol Ther 1992;52:125–33.

4. Ardissino D, Merlini PA, Savonitto S, et al. Effect of transdermal nitroglycerin or N-acetyl cysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol 1997;29:941–7.

5. Hogan JC, Lewis MJ, Henderson AH. N-acetylcysteine fails to attenuate haemodynamic tolerance to glycerol trinitrate in healthy volunteers. Br J Clin Pharmacol 1989;28:421–6.

6. Hogan JC, Lewis MJ, Henderson AH. Chronic administration of N-acetylcysteine fails to prevent nitrate tolerance in patients with stable angina pectoris. Br J Clin Pharmacol 1990;30:573–7.

7. Watanabe H, Kakihana M, Sadanori O, Sugishita Y. Randomized, double-blind, placebo-controlled study of the preventive effect of supplemental oral vitamin C on attenuation of development of nitrate tolerance. J Am Coll Cardiol 1998;31:1323–9.

8. Bassenge E, Fink N, Skatchkov M, Fink B. Dietary supplement with vitamin C prevents nitrate tolerance. J Clin Invest 1998;102:67–71.

9. Thelkeld DS, ed. Diuretics and Cardiovasculars, Antianginal Agents, Nitrates. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Apr 1992, 143f–4a.

Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.

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Interactions with Dietary Supplements

Interactions with Foods and Other Compounds