Issue Section:. You do not currently have access to this article. Download all slides. Comments 0. Add comment Close comment form modal. I agree to the terms and conditions. You must accept the terms and conditions. Add comment Cancel. Submit a comment. Comment title. You have entered an invalid code. Submit Cancel.
Thank you for submitting a comment on this article. Your comment will be reviewed and published at the journal's discretion. Please check for further notifications by email. Sign in Don't already have an Oxford Academic account? You could not be signed in. Sign In Forgot password? Don't have an account? Sign in via your Institution Sign in. Purchase Subscription prices and ordering for this journal Short-term Access To purchase short term access, please sign in to your Oxford Academic account above.
This article is also available for rental through DeepDyve. View Metrics. Email alerts Article activity alert. New issue alert. Receive exclusive offers and updates from Oxford Academic. Related articles in Web of Science Google Scholar. Citing articles via Web of Science Pharmacotherapy for nontuberculous mycobacterial pulmonary disease. Practice-enhancing publications about the medication-use process in Do we still need to be concerned about postsurgical opioid prescribing?
Alteplase: Major Two separate studies have shown that concomitant administration of IV nitroglycerin can compromise the therapeutic efficacy of alteplase. In another controlled study, patients who did not receive concomitant IV nitroglycerin reperfused faster, more often, and had fewer reocclusions. It appears that when combined in vitro, nitroglycerin enhances the degradation of alteplase.
Nitroglycerin may enhance the hepatic clearance of alteplase since alteplase plasma concentrations are lower in patients receiving concomitant nitroglycerin. Amitriptyline: Minor Nitroglycerin can cause hypotension. This action may be additive with other agents that can cause hypotension such as antidepressants.
Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with antidepressants. Amoxapine: Minor Nitroglycerin can cause hypotension. This action may be additive with other agents that can cause hypotension such as heterocyclic antidepressants. Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with these antidepressants. Angiotensin II receptor antagonists: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Angiotensin-converting enzyme inhibitors: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Apomorphine: Major Coadministration of apomorphine and nitrates can cause large decreases in blood pressure. The effect is especially of concern with use of sublingual nitroglycerin products. Instruct patients to lie down before taking a sublingual nitroglycerin dose and to remain supine for at least 45 minutes after to reduce orthostatic risk.
In one evaluation, the largest mean decreases in standing systolic and diastolic blood pressure during use of apomorphine and sublingual nitroglycerin were The largest recorded decreases in standing systolic and diastolic blood pressures were 65 mmHg and 43 mmHg during use of apomorphine and sublingual nitroglycerin together.
Articaine; Epinephrine: Moderate Coadministration of articaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Monitor patients closely for signs and symptoms of methemoglobinemia if coadministration is necessary. If methemoglobinemia occurs or is suspected, discontinue articaine and any other oxidizing agents. Depending on the severity of symptoms, patients may respond to supportive care; more severe symptoms may require treatment with methylene blue, exchange transfusion, or hyperbaric oxygen.
Minor Nitroglycerin can cause hypotension. Atomoxetine: Minor Nitroglycerin can cause hypotension. Belladonna Alkaloids; Ergotamine; Phenobarbital: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized.
Because of the potential to cause coronary vasospasm, ergot alkaloids can oppose the vasodilatory actions of nitroglycerin and, in doing so, may precipitate angina. In addition, oral administration of nitroglycerin decreases the first-pass metabolism of dihydroergotamine, thereby increasing its oral bioavailability. Belladonna; Opium: Minor Nitroglycerin can cause hypotension. Benzalkonium Chloride; Benzocaine: Moderate Rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine products.
Nitrates may also induce methemoglobin formation that will be additive to that formed by benzocaine products. Therefore, caution is warranted when combining nitrate medications with topical or oromucosal benzocaine products.
Patients using OTC benzocaine gels and liquids should be advised to seek immediate medical attention if signs or symptoms of methemoglobinemia develop. In addition, clinicians should closely monitor patients for the development of methemoglobinemia when benzocaine sprays are used during a procedure.
Benzhydrocodone; Acetaminophen: Minor Nitroglycerin can cause hypotension. Benzocaine: Moderate Rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine products. Benzocaine; Butamben; Tetracaine: Moderate Rare and sometimes fatal cases of methemoglobinemia have been reported with the use of topical or oromucosal benzocaine products. Benzodiazepines: Minor Nitroglycerin can cause hypotension. Beta-adrenergic blockers: Moderate Nitroglycerin can cause hypotension.
This action may be additive with other agents that can cause hypotension such as antihypertensive agents or other peripheral vasodilators. Patients should be monitored more closely for hypotension if nitroglycerin, including nitroglycerin rectal ointment, is used concurrently with any beta-blockers. Bosentan: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Brompheniramine; Guaifenesin; Hydrocodone: Minor Nitroglycerin can cause hypotension. Bupivacaine Liposomal: Moderate Coadministration of bupivacaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
If methemoglobinemia occurs or is suspected, discontinue bupivacaine and any other oxidizing agents. Bupivacaine: Moderate Coadministration of bupivacaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
Bupivacaine; Lidocaine: Moderate Coadministration of bupivacaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue lidocaine and any other oxidizing agents.
Bupivacaine; Meloxicam: Moderate Coadministration of bupivacaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
Bupropion: Minor Nitroglycerin can cause hypotension. Bupropion; Naltrexone: Minor Nitroglycerin can cause hypotension. Cabergoline: Moderate Cabergoline should be used cautiously with drugs that can lower blood pressure, including systemic nitrates.
Cabergoline has been associated with hypotension. Initial doses of cabergoline higher than 1 mg may produce orthostatic hypotension. It may be advisable to monitor blood pressure. Calcium-channel blockers: Moderate Nitroglycerin can cause hypotension. This action may be additive with other agents that can cause hypotension such as calcium-channel blockers. Patients should be monitored more closely for hypotension if nitroglycerin, including nitroglycerin rectal ointment, is used concurrently with a calcium-channel blocker.
Carbonic anhydrase inhibitors: Moderate Nitrates can cause hypotension. Central-acting adrenergic agents: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Chlordiazepoxide: Minor Nitroglycerin can cause hypotension. Chlordiazepoxide; Amitriptyline: Minor Nitroglycerin can cause hypotension. Chlordiazepoxide; Clidinium: Minor Nitroglycerin can cause hypotension. Chloroprocaine: Moderate Coadministration of chloroprocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
If methemoglobinemia occurs or is suspected, discontinue chloroprocaine and any other oxidizing agents. Chlorpheniramine; Codeine: Minor Nitroglycerin can cause hypotension. Chlorpheniramine; Hydrocodone: Minor Nitroglycerin can cause hypotension. Chlorpromazine: Minor Nitroglycerin can cause hypotension.
This action may be additive with other agents that can cause hypotension such as phenothiazines. Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with phenothiazines.
Citalopram: Minor Nitroglycerin can cause hypotension. Clomipramine: Minor Nitroglycerin can cause hypotension. Clonazepam: Minor Nitroglycerin can cause hypotension. Clorazepate: Minor Nitroglycerin can cause hypotension. Cocaine: Major Use of cocaine with antihypertensive agents may increase the antihypertensive effects of the antihypertensive medications or may potentiate cocaine-induced sympathetic stimulation.
Codeine: Minor Nitroglycerin can cause hypotension. Codeine; Guaifenesin: Minor Nitroglycerin can cause hypotension. Codeine; Promethazine: Minor Nitroglycerin can cause hypotension. Dapsone: Moderate Coadministration of dapsone with nitrates may increase the risk of developing methemoglobinemia.
Advise patients to discontinue treatment and seek immediate medical attention with any signs or symptoms of methemoglobinemia. Desipramine: Minor Nitroglycerin can cause hypotension. Dextromethorphan; Quinidine: Moderate Nitroglycerin can cause hypotension. This action may be additive with other agents that can cause hypotension such as quinidine. Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with quinidine.
Diazepam: Minor Nitroglycerin can cause hypotension. Diazoxide: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dihydroergotamine: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized.
Doxepin: Minor Nitroglycerin can cause hypotension. Duloxetine: Minor Nitroglycerin can cause hypotension. Eplerenone: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Epoprostenol: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Ergoloid Mesylates: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized.
Ergonovine: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized. Ergot alkaloids: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized.
Ergotamine: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized.
Ergotamine; Caffeine: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized. Escitalopram: Minor Nitroglycerin can cause hypotension.
Estazolam: Minor Nitroglycerin can cause hypotension. Ethanol: Moderate Alcohol may increase the frequency of nitroglycerin-related adverse effects including lightheadedness on standing, especially just after rising from a recumbent or seated position.
The vasodilating effects of nitroglycerin may also be additive with those of alcohol. Fenoldopam: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Fentanyl: Minor Nitroglycerin can cause hypotension. Fluoxetine: Minor Nitroglycerin can cause hypotension.
Fluphenazine: Minor Nitroglycerin can cause hypotension. Flurazepam: Minor Nitroglycerin can cause hypotension. Fluvoxamine: Minor Nitroglycerin can cause hypotension. Gallium Ga 68 Dotatate: Moderate Nitrates can cause hypotension. Glimepiride; Rosiglitazone: Major The concomitant use of nitrates with rosiglitazone is not recommended. An increased risk of myocardial ischemia was observed in a subset of patients receiving nitrates with rosiglitazone. Most patients that were using nitrates had preexisting coronary artery disease.
In patients with coronary artery disease that were not on nitrates, rosiglitazone therapy did not increase the risk of myocardial ischemia. Guaifenesin; Hydrocodone: Minor Nitroglycerin can cause hypotension. Halothane: Moderate General anesthetics can potentiate the hypotensive effects of other antihypertensive agents and nitrates. Heparin: Minor At high doses, nitroglycerin may interfere with the anticoagulant effect of heparin. Intravenous nitroglycerin can induce heparin resistance. Monitor for lack of heparin efficacy if these drugs are administered concurrently.
However, this interaction is not likely of clinical significance since heparin therapy is adjusted to the partial thromboplastin time aPTT and other clinical parameters of the patient. Heterocyclic antidepressants: Minor Nitroglycerin can cause hypotension.
Homatropine; Hydrocodone: Minor Nitroglycerin can cause hypotension. Hydralazine: Moderate Concomitant use of nitrates with antihypertensives can cause additive hypotensive effects. A study of 28 patients with heart failure indicated that concomitant administration of oral hydralazine prevented the development of tolerance to continuous nitroglycerin infusions.
Hydralazine; Hydrochlorothiazide, HCTZ: Moderate Concomitant use of nitrates with antihypertensives can cause additive hypotensive effects.
Hydrocodone: Minor Nitroglycerin can cause hypotension. Hydrocodone; Ibuprofen: Minor Nitroglycerin can cause hypotension. Hydrocodone; Potassium Guaiacolsulfonate: Minor Nitroglycerin can cause hypotension. Hydromorphone: Minor Nitroglycerin can cause hypotension. Ibuprofen; Oxycodone: Minor Nitroglycerin can cause hypotension. Iloprost: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Imipramine: Minor Nitroglycerin can cause hypotension. Isocarboxazid: Moderate Nitroglycerin can cause hypotension. This action may be additive with other agents that can cause hypotension such as monoamine oxidase inhibitors MAOIs. Patients should be monitored more closely for hypotension if nitroglycerin is used concurrently with MAOIs.
Levorphanol: Minor Nitroglycerin can cause hypotension. Lidocaine: Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Lidocaine; Prilocaine: Moderate Coadministration of lidocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
Moderate Coadministration of prilocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue prilocaine and any other oxidizing agents.
Loop diuretics: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Lorazepam: Minor Nitroglycerin can cause hypotension. Mannitol: Moderate Nitrates can cause hypotension. Maprotiline: Minor Nitroglycerin can cause hypotension. Mecamylamine: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Mepenzolate: Moderate Additive anticholinergic effects may be seen when mepenzolate is used concomitantly with nitrates. Clinicians should note that antimuscarinic effects might be seen not only on GI smooth muscle, but also on bladder function, the eye, and temperature regulation. Additive drowsiness may also occur. Meperidine: Minor Nitroglycerin can cause hypotension. Meperidine; Promethazine: Minor Nitroglycerin can cause hypotension. Mepivacaine: Moderate Coadministration of mepivacaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
If methemoglobinemia occurs or is suspected, discontinue mepivacaine and any other oxidizing agents. Mepivacaine; Levonordefrin: Moderate Coadministration of mepivacaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Mesoridazine: Minor Nitroglycerin can cause hypotension. Metformin; Rosiglitazone: Major The concomitant use of nitrates with rosiglitazone is not recommended.
Methadone: Minor Nitroglycerin can cause hypotension. Methazolamide: Moderate Nitrates can cause hypotension. Methylergonovine: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized. Methysergide: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized.
Midazolam: Minor Nitroglycerin can cause hypotension. Minoxidil: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Monoamine oxidase inhibitors: Moderate Nitroglycerin can cause hypotension. Morphine: Minor Nitroglycerin can cause hypotension. Morphine; Naltrexone: Minor Nitroglycerin can cause hypotension. Nefazodone: Minor Nitroglycerin can cause hypotension. Nesiritide, BNP: Major The potential for hypotension may be increased when coadministering nesiritide with other vasodilators or hypotensive drugs, such as nitrates. Nitroprusside: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Nortriptyline: Minor Nitroglycerin can cause hypotension. Olanzapine; Fluoxetine: Minor Nitroglycerin can cause hypotension. Oliceridine: Minor Nitroglycerin can cause hypotension. Opiate Agonists: Minor Nitroglycerin can cause hypotension. Oxazepam: Minor Nitroglycerin can cause hypotension. Oxycodone: Minor Nitroglycerin can cause hypotension.
Oxymorphone: Minor Nitroglycerin can cause hypotension. Paliperidone: Moderate Paliperidone may cause orthostatic hypotension and enhance the orthostatic effects of nitrates. Orthostatic vital signs should be monitored in patients receiving paliperidone and nitrates who are susceptible to hypotension. Paroxetine: Minor Nitroglycerin can cause hypotension.
Penicillin G Benzathine; Penicillin G Procaine: Moderate Coadministration of penicillin G procaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. If methemoglobinemia occurs or is suspected, discontinue penicillin G procaine and any other oxidizing agents. Penicillin G Procaine: Moderate Coadministration of penicillin G procaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Pergolide: Contraindicated Ergot alkaloids are contraindicated in patients with hypertension, angina, or coronary artery disease; which are the primary patient populations for which nitroglycerin is utilized.
Perphenazine: Minor Nitroglycerin can cause hypotension. Perphenazine; Amitriptyline: Minor Nitroglycerin can cause hypotension. Phenelzine: Moderate Nitroglycerin can cause hypotension. Phenothiazines: Minor Nitroglycerin can cause hypotension.
Phosphodiesterase inhibitors: Contraindicated Coadministration of phosphodiesterase inhibitors with organic nitrates or nitrites in any dosage formulation is contraindicated. Deaths have been reported in men who were using sildenafil while taking nitrate or nitrite therapy for angina. Potassium-sparing diuretics: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Prilocaine: Moderate Coadministration of prilocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
Prilocaine; Epinephrine: Moderate Coadministration of prilocaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia. Procainamide: Moderate Nitroglycerin can cause hypotension. This action may be additive with other agents that can cause hypotension such as procainamide. Procaine: Moderate Local anesthetics may cause additive hypotension in combination with antihypertensive agents.
Prochlorperazine: Minor Nitroglycerin can cause hypotension. Promethazine: Minor Nitroglycerin can cause hypotension. Promethazine; Dextromethorphan: Minor Nitroglycerin can cause hypotension. Propoxyphene: Minor Nitroglycerin can cause hypotension. Protriptyline: Minor Nitroglycerin can cause hypotension. Quazepam: Minor Nitroglycerin can cause hypotension.
Quinidine: Moderate Nitroglycerin can cause hypotension. Remifentanil: Minor Nitroglycerin can cause hypotension. Remimazolam: Minor Nitroglycerin can cause hypotension. Reserpine: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects.
Riociguat: Contraindicated Coadministration of riociguat and nitrates or nitric oxide donors e. The blood pressure lowering effect of sublingual nitroglycerin was potentiated when administered 4 and 8 hours after riociguat. Syncope was reported in some patients. Ropivacaine: Moderate Coadministration of ropivacaine with oxidizing agents, such as nitrates, may increase the risk of developing methemoglobinemia.
If methemoglobinemia occurs or is suspected, discontinue ropivacaine and any other oxidizing agents. Rosiglitazone: Major The concomitant use of nitrates with rosiglitazone is not recommended.
Selective serotonin reuptake inhibitors: Minor Nitroglycerin can cause hypotension. Sertraline: Minor Nitroglycerin can cause hypotension.
Sincalide: Moderate Sincalide-induced gallbladder ejection fraction may be affected by concurrent nitrates. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of procedure results.
Sufentanil: Minor Nitroglycerin can cause hypotension. Tapentadol: Minor Nitroglycerin can cause hypotension. Temazepam: Minor Nitroglycerin can cause hypotension. Tetracaine: Moderate Local anesthetics may cause additive hypotension in combination with antihypertensive agents.
Use extreme caution with the concomitant use of tetracaine and antihypertensive agents or rapid-onset vasodilators, such as nitrates. Thiazide diuretics: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Thiethylperazine: Minor Nitroglycerin can cause hypotension. Thioridazine: Minor Nitroglycerin can cause hypotension.
Tramadol: Minor Nitroglycerin can cause hypotension. Tramadol; Acetaminophen: Minor Nitroglycerin can cause hypotension. Tranylcypromine: Moderate Nitroglycerin can cause hypotension.
Treprostinil: Moderate Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Triazolam: Minor Nitroglycerin can cause hypotension. Tricyclic antidepressants: Minor Nitroglycerin can cause hypotension. Trifluoperazine: Minor Nitroglycerin can cause hypotension. Trimipramine: Minor Nitroglycerin can cause hypotension. Similar to other nitrites and organic nitrates, nitroglycerin is converted to nitric oxide NO , a reactive free radical.
Nitric oxide, the active intermediate compound common to all agents of this class, activates the enzyme guanylate cyclase, thereby stimulating the synthesis of cyclic guanosine 3',5'-monophosphate cGMP. This second messenger then activates a series of protein kinase-dependent phosphorylations in the smooth muscle cells, eventually resulting in the dephosphorylation of the myosin light chain of the smooth muscle fiber and the subsequent release, or extrusion, of calcium ions.
The contractile state of smooth muscle is normally maintained by a phosphorylated myosin light chain stimulated by an increase in calcium ions. Thus, the nitrite- or nitrate-induced dephosphorylation of the myosin light chain signals the cell to release calcium, thereby relaxing the smooth muscle cells and producing vasodilation. It is believed that nitrates correct myocardial oxygen imbalances by reducing systemic and pulmonary arterial pressure afterload and decreasing cardiac output secondary to peripheral dilation rather than coronary artery dilation.
0コメント