Nitroglycerin (drug interactions)
Nitroglycerin is a widely prescribed medication primarily used for the quick relief of anginal pain, a symptom associated with coronary artery disease. However, it is important for patients and healthcare providers to be aware of potential drug interactions that can affect the efficacy and safety of nitroglycerin. Certain dietary supplements, including N-acetylcysteine (NAC), vitamin C, arginine, folate, and vitamin E, may offer benefits by helping to prevent tolerance to nitroglycerin. However, these interactions can also lead to unpleasant side effects or complications.
Conversely, some substances such as hawthorn, garlic, L-arginine, and Coenzyme Q10 may dangerously lower blood pressure when combined with nitroglycerin. Moreover, prescription medications, particularly phosphodiesterase-5 (PDE5) inhibitors, ergot alkaloids, and specific antidepressants, can also pose significant risks when taken with nitroglycerin. To ensure safety, individuals on nitroglycerin should consult healthcare professionals before adding any supplements or new medications to their regimen and should avoid alcohol and grapefruit juice.
Nitroglycerin (drug interactions)
DEFINITION: A commonly used drug treatment for quick relief of anginal pain.
INTERACTIONS: Arginine, folate, N-acetylcysteine, vitamin C, vitamin E, hawthorn, garlic, L-arginine, Coenzyme Q10 (CoQ10), various prescription medications
TRADE NAMES: Deponit, Minitran, Nitrek, Nitro-Bid, Nitro-Derm, Nitro-Dur, Nitro-Time, Nitrocine, Nitrodisc, Nitrogard, Nitroglyn, Nitrol, Nitrolingual, Nitrong, NitroQuick, Nitrostat, Transderm-Nitro
RELATED DRUGS: Isosorbide dinitrate, isosorbide mononitrate
N-acetylcysteine (NAC)
Effect: Possible Benefits and Risks
NAC is a specially modified form of the dietary amino acid cysteine with various proposed uses. Nitrates such as nitroglycerin lose some of their effectiveness over time. According to some studies, the supplement N-acetylcysteine might help these drugs work better. However, the combination of NAC and nitroglycerin appears to cause severe headaches.
Taking NAC with nitroglycerin may be beneficial in some cases. However, unpleasant side effects probably limit the use of this combination.
Angina is too serious a disease for self-treatment. Persons with angina should not take any supplement except on a physician’s advice.
Vitamin C
Effect: Supplementation Possibly Helpful
Vitamin C may help prevent the development of tolerance to nitrate medications such as nitroglycerin. According to a double-blind study of forty-eight persons, using vitamin C at a dose of 2,000 milligrams (mg) three times daily helped maintain the effectiveness of nitroglycerin. Other studies support these findings.
Angina is too serious a disease for self-treatment. Persons with angina should not take any supplement except on a physician’s advice.
Arginine
Effect: Supplementation Possibly Helpful
According to a small, double-blind, placebo-controlled crossover study, using arginine (700 mg four times daily) may help prevent tolerance to nitrate medications.
Folate
Effect: Supplementation Possibly Helpful
A small, double-blind trial suggests that folate supplements (at a high dose of 10 mg daily) may help prevent tolerance to nitrate medications.
Vitamin E
Effect: Supplementation Possibly Helpful
A small, double-blind trial suggests that 200 mg of vitamin E three times daily may help prevent tolerance to nitrate medications.
Other Interactions
Although the substances listed above are beneficial to individuals taking nitroglycerin medications, several harmful interactions exist as well. Hawthorn, garlic, L-arginine, and CoQ10 can all potentially lower blood pressure to dangerous levels when taken with nitroglycerin. Additionally, several prescription medications may interact with nitroglycerin as well. Phosphodiesterase-5 (PDE5) Inhibitors, which treat erectile dysfunction, ergot alkaloids to treat migraine headaches, and riociguat and vericiguat to treat pulmonary hypertension, can all cause dangerous interactions with nitroglycerin. Other medications, including certain antidepressants, can also be harmful. Individuals taking nitroglycerin should avoid alcohol and grapefruit juice.
Bibliography
Aremu, Femi. "Nitroglycerin: Side Effects, Dosage, Uses, and More." Healthline, 4 Aug. 2021, www.healthline.com/health/drugs/nitroglycerin-sublingual-tablet#interactions. Accessed 8 Sept. 2024.
Bassenge, E., et al. "Dietary Supplement with Vitamin C Prevents Nitrate Tolerance." Journal of Clinical Investigation, vol. 31, 1998, pp. 67-71.
Daniel, T. A., and J. J. Nawarskas. "Vitamin C in the Prevention of Nitrate Tolerance." Annals of Pharmacotherapy, vol. 4, 2000, pp. 1193-1197.
Gori, T., et al. "Folic Acid Prevents Nitroglycerin-Induced Nitric Oxide Synthase Dysfunction and Nitrate Tolerance: A Human In Vivo Study." Circulation, vol. 104, 2001, pp. 1119-1123.
McVeigh, G. E., et al. "Platelet Nitric Oxide and Superoxide Release During the Development of Nitrate Tolerance: Effect of Supplemental Ascorbate." Circulation, vol. 106, 2002, pp. 208-213.
"Nitroglycerine (Oral Route, Sublingual Route)." Mayo Clinic, 1 Sept. 2024, www.mayoclinic.org/drugs-supplements/nitroglycerin-oral-route-sublingual-route/before-using/drg-20072863. Accessed 8 Sept. 2024.
"Nitroglycerin - StatPearls." NCBI, www.ncbi.nlm.nih.gov/books/NBK482382. Accessed 8 Sept. 2024.
Parker, J. O., et al. "The Effect of Supplemental L-arginine on Tolerance Development During Continuous Transdermal Nitroglycerin Therapy." Journal of the American College of Cardiology, vol. 39, 2002, pp. 1199-1203.
Watanabe, H., et al. "Randomized, Double-Blind, Placebo-Controlled Study of the Preventive Effect of Supplemental Oral Vitamin C on Attenuation of Development of Nitrate Tolerance." Journal of the American College of Cardiology, vol. 31, 1998, pp. 1323-1329.