Also indexed as: Deponit, Minitran, Nitrek, Nitro-Bid,
Nitro-Dur, Nitro-Time, Nitrodisc, Nitrogard, Nitroglyn, Nitrol, Nitrolingual, Nitrostat,
Transderm-Nitro, Tridil
Nitroglycerin 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, and Foods
In some cases, an 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 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.1 2 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.3
4 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.5 6
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.7 In another controlled clinical trial, similar protection was achieved
with 500 mg three times daily.8
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.
Interactions with Foods and Other Compounds
Alcohol
Alcohol, when consumed during nitroglycerin therapy, may cause low blood pressure and
circulatory collapse in extreme cases.9 People using nitroglycerin should avoid
alcohol.
References: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.