Nitroglycerin
Common brand names:
Nitro-Bid, Nitro-Dur, Nitrostat, NitroQuickNitroglycerin dilates blood vessels by relaxing the smooth muscles surrounding them, increasing blood flow. Nitroglycerin 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, & Foods
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Supportive Interactions
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Support Medicine
Nitroglycerin
N-Acetyl Cysteine
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
The beneficial effects of ISDN are reduced following long-term treatment with the drug through a process known as tolerance. Controlled studies have shown that using intravenous and oral N-acetyl cysteine (NAC) reverses or prevents tolerance to nitrates. Another controlled study revealed that intravenous NAC enhanced the beneficial effects of ISDN on heart function. Therefore, people taking isosorbide dinitrate might benefit from supplemental NAC.
N-Acetyl CysteineNitroglycerin- Boesgaard S, Aldershvile J, Poulsen HE. Preventive administration of intravenous N-acetylcysteine and development of tolerance to isosorbide dinitrate in patients with angina pectoris. Circulation 1992;85:143-9.
- Vincent J, Kongpatanakul S, Blaschke TF, Hoffman BB. Desensitization of nitrate-induced venodilation: reversal with oral N-acetylcysteine in humans. J Cardiovasc Pharmacol 1992;20:907-12.
- Mehra A, Shotan A, Ostrzega E, et al. Potentiation of isosorbide dinitrate effects with N-acetylcysteine in patients with chronic heart failure. Circulation 1994;89:2595-600.
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Support Medicine
Nitroglycerin
Vitamin C
Vitamin C may help maintain the blood vessel dilation response to nitroglycerin. A double-blind study found that individuals taking 2 grams of vitamin C three times per day did not tend to develop nitroglycerin tolerance over time compared to those taking placebo. In another controlled clinical trial, similar protection was achieved with 500 mg three times daily.
People using long-acting nitroglycerin can avoid tolerance with a ten- to twelve-hour hour nitroglycerin-free period every day. People taking long-acting nitroglycerin should ask their prescribing doctor or pharmacist about preventing nitroglycerin tolerance.
Vitamin CNitroglycerin- Watanabe H, Kakihana M, Ohtsuka S, 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.
- Bassenge E, Fink N, Skatchkov M, Fink B. Dietary supplement with vitamin C prevents nitrate tolerance. J Clin Invest 1998;102:67-71.
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Explanation Required
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Needs Explanation
Nitroglycerin
N-Acetyl Cysteine
Continuous nitroglycerin use leads to development of nitroglycerin tolerance and loss of effectiveness. Intravenous (iv) N-acetyl cysteine (NAC), during short-term studies of people receiving continuous nitroglycerin, was reported to reverse nitroglycerin tolerance. In a double-blind study of patients with unstable angina, transdermal nitroglycerin plus oral NAC (600 mg three times per day) was associated with fewer failures of medical treatment than placebo, NAC, or nitroglycerin alone. However, when combined with nitroglycerin use, NAC has led to intolerable headaches. In two double-blind, randomized trials of angina patients treated with transdermal nitroglycerin, oral NAC 200 mg or 400 mg three times per day failed to prevent nitroglycerin tolerance.
N-Acetyl CysteineNitroglycerin- 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.
- 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.
- Iversen HK. N-acetylcysteine enhances nitroglycerin-induced headache and cranial artery response. Clin Pharmacol Ther 1992;52:125-33.
- Ardissino D, Merlini PA, Savonitto S, et al. Effect of transdermal nitroglycerin or N-acetylcysteine, or both, in the long-term treatment of unstable angina pectoris. J Am Coll Cardiol 1997;29:941-7.
- 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.
- 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.
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