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Nitroglycerin Disease Interactions

There are 8 disease interactions with nitroglycerin:

Nitrates/Nitrites (Includes Nitroglycerin) ↔ Ami

Severe Potential Hazard, High plausibility

Applies to: Myocardial Infarction

The use of organic nitrates and nitrites in the early days following an acute myocardial infarction (AMI) should be accompanied by careful clinical and hemodynamic monitoring to avoid the possibility of systemic hypotension and tachycardia, which can exacerbate myocardial ischemia. In general, oral or long-acting formulations of these drugs should not be used in the early management of AMI because of the difficulty in precisely controlling and rapidly terminating their hemodynamic effects should adverse reactions occur. Sublingual and other immediate-onset nitrates or nitrites should typically be avoided in suspected AMI with marked bradycardia or tachycardia, and should be used with extreme caution, if at all, in patients with right ventricular or inferior wall infarction. Rarely, sublingual nitroglycerin has produced hypotension accompanied by paradoxical bradycardia in patients with AMI and especially right ventricular infarction. The latter group of patients are also particularly dependent on adequate right ventricular preload to maintain cardiac output and can experience profound hypotension with nitrate or nitrite administration due to reduction of right ventricular preload.

References

  1. "Product Information. Nitrostat (nitroglycerin)." Parke-Davis, Morris Plains, NJ.
  2. Scardi S, Zingone B, Pandullo C "Myocardial infarction following sublingual administration of isosorbide dinitrate." Int J Cardiol 26 (1990): 378-9
  3. Berisso MZ, Cavallini A, Iannetti M "Sudden death during continuous Holter monitoring out of hospital after nitroglycerin consumption." Am J Cardiol 54 (1984): 677-9
View all 11 references

Nitrates/Nitrites (Includes Nitroglycerin) ↔ Hemodialysis

Severe Potential Hazard, High plausibility

Applies to: hemodialysis

The combined effect of organic nitrates or nitrites with hemodialysis, which often lowers blood pressure, can cause life-threatening hypotension. Therapy with these agents should be administered cautiously in patients requiring hemodialysis. The medication should be withheld before undergoing dialysis, and hemodynamic stability should be established prior to resumption of medication following dialysis. Nitroglycerin and isosorbide dinitrate are moderately dialyzed.

References

  1. Imamura T, Tamura K, Taguchi T, Minoda M, Seita M "Reduction of nitroglycerin and isosorbide dinitrate by hemodialysis in refractory angina pectoris after acute myocardial infarction." Am J Cardiol 61 (1988): 954-5
  2. Dunetz PS "Dialysis patients and nitrates." Nursing 22 (1992): 4

Nitrates/Nitrites (Includes Nitroglycerin) ↔ Intracranial Pressure

Severe Potential Hazard, High plausibility

Applies to: Head Injury, Intracranial Hemorrhage, Intracranial Hypertension, Brain/Intracranial Tumor

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

References

  1. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.
  2. Hannerz J, Greitz D "Cerebrospinal fluid pressure and venous pressure in "dynamite headache" and cluster headache attacks." Headache 32 (1992): 436-8
  3. Gagnon RL, Marsh ML, Smith RW, Shapiro HM "Intracranial hypertension caused by nitroglycerin." Anesthesiology 51 (1979): 86-7
View all 6 references

Nitroglycerin (Iv) (Includes Nitroglycerin) ↔ Pericarditis

Severe Potential Hazard, High plausibility

Applies to: Constrictive Pericarditis, Pericardial Tamponade, Restrictive Cardiomyopathy

The use of intravenous nitroglycerin is contraindicated in patients with constrictive pericarditis, pericardial tamponade, or restrictive cardiomyopathy. In these patients, cardiac output is dependent upon venous return, which can be reduced by nitroglycerin due to venous pooling. Also, nitroglycerin-induced hypotension may lead to paradoxical bradycardia and increased angina pectoris.

References

  1. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.

Nitrates/Nitrites (Includes Nitroglycerin) ↔ Anemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Anemia

Some manufacturers and medical references consider the use of nitrates and nitrites to be contraindicated in patients with severe anemia. Nitrates and nitrites can cause methemoglobinemia, primarily in high-dose intravenous therapy or acute poisoning and in patients with NADH reductase deficiency. However, elevations of methemoglobin may also occur with commonly used dosages. While probably not of routine clinical significance, the increases may be important in certain patient populations such as those with coronary insufficiency or anemia.

References

  1. Arsura E, Lichstein E, Guadagnino V, Nicchi V, Sanders M, Hollander G, Greengart A "Methemoglobin levels produced by organic nitrates in patients with coronary artery disease." J Clin Pharmacol 24 (1984): 160-4
  2. Saxon SA, Silverman ME "Effects of continuous infusion of intravenous nitroglycerin on methemoglobin levels." Am J Cardiol 56 (1985): 461-4
  3. Sutton M, Jeffrey B "Acquired methemoglobinemia from amyl nitrate inhalation." J Emerg Nurs 18 (1992): 8-9
View all 14 references

Nitrates/Nitrites (Includes Nitroglycerin) ↔ Hypertrophic Cardiomyopathy

Moderate Potential Hazard, High plausibility

Applies to: Hypertrophic Cardiomyopathy

Organic nitrates and nitrites may aggravate the angina associated with hypertrophic cardiomyopathy and should be administered cautiously in patients with this condition.

References

  1. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.
  2. "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Nitrostat (nitroglycerin)." Parke-Davis, Morris Plains, NJ.
View all 4 references

Nitrates/Nitrites (Includes Nitroglycerin) ↔ Hypotension

Moderate Potential Hazard, High plausibility

Applies to: Hypotension, Dehydration, Cerebrovascular Insufficiency, Shock

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure < 90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration.

References

  1. "Product Information. ISMO (isosorbide mononitrate)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Tridil (nitroglycerin)." DuPont Pharmaceuticals, Wilmington, DE.
  3. Ong EA, Bass S "Nitroglycerin-induced bradycardia and hypotension in acute myocardial infarction." Chest 77 (1980): 244
View all 12 references

Nitrates/Nitrites (Includes Nitroglycerin) ↔ Glaucoma

Minor Potential Hazard, Low plausibility

Applies to: Glaucoma/Intraocular Hypertension

Some medical references state that organic nitrates and nitrites may increase intraocular pressure and should be used with caution in patients with glaucoma. However, the effect on intraocular pressure is variable and brief, and there is no evidence that these drugs precipitate narrow-angle glaucoma. Amyl nitrate typically may cause a slight rise of 3+ mm for several seconds followed by a fall in intraocular pressure for 10 to 20 minutes, the latter secondary to a fall in blood pressure. Nitroglycerin rarely produces ocular side effects, and oral nitroglycerin appears to have few to no significant ocular side effects.

References

  1. Fraunfelder FT, Fraunfelder FW; Randall JA "Drug-Induced Ocular Side Effects 5th" Boston, MA: Butterworth-Heinemann (2001):

You should also know about...

nitroglycerin drug Interactions

There are 376 drug interactions with nitroglycerin

nitroglycerin alcohol/food Interactions

There is 1 alcohol/food interaction with nitroglycerin

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2014 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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