nitroglycerin (cont.)
Capsules of long-acting nitroglycerin also are
used for prevention. The usual dose is 2.5-9 mg administered 2 to 3 times per
day 1 to 2 hours after a meal. Capsules should be swallowed whole and not
chewed.
DRUG INTERACTIONS: Since nitroglycerin can cause hypotension (low
blood pressure), other medications which also cause hypotension may produce
severe hypotension. Such drugs might include medicines used to treat high blood
pressure, some antidepressants; some anti-psychotics, quinidine
(Quinaglute, Quinidex), procainamide
(Pronestyl, Procan-SR, Procanbid),
benzodiazepines such as diazepam (Valium) or opiates,
for example, morphine. Since
alcohol also may intensify the blood pressure lowering effect of nitroglycerin,
patients receiving nitroglycerin should be advised to drink alcoholic beverages
with caution.
Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) exaggerate
the blood pressure lowering effects of nitroglycerin and may cause excessive
blood pressure reduction. Patients taking nitrates should not receive
sildenafil, tadalafil or vardenafil.
Ergot alkaloids, for example, ergotamine with caffeine-rectal (Cafergot,
Migergot), and sumatriptan (Imitrex) can oppose the vasodilatory actions of
nitroglycerin and may cause angina. A similar effect can occur with ephedrine
and the decongestants pseudoephedrine (Sudafed) and propanolamine which is
contained in many drugs used for treating the symptoms of colds.
PREGNANCY: Nitroglycerin has not been adequately studied in
pregnant
women.
NURSING MOTHERS: It is not known if nitroglycerin is secreted in
breast milk.
SIDE EFFECTS: A persistent, throbbing headache commonly occurs with
nitroglycerin therapy. Aspirin, acetaminophen, or ibuprofen may be used to
relieve the pain. Flushing of the head and neck can occur with nitroglycerin
therapy as can an increase in heart rate or palpitations. This can be associated
with a drop in blood pressure which can be accompanied by dizziness or weakness.
To reduce the risk of low blood pressure, patients often are told to sit or lie
down during and immediately after taking nitroglycerin.
Reference: FDA Prescribing Information
Last Editorial Review: 3/26/2009
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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