Nitroglycerininteractions
nitroglycerin 0.004 MG/MG Rectal Ointment
This is the interactions section of this product’s FDA label — what the manufacturer documented for this drug. It is not a check of your medication list, and a drug missing from it has not been cleared: licensed clinical databases list far more interactions than any single label does. Before combining medicines, ask a pharmacist, who can check everything you take at once and will do it for free.
Named on this label
Every name above is printed in the text below. This is not the full set of drugs that interact with this one — it is the set this manufacturer wrote down.
Drug interactions
PDE5 inhibitors: potentiation of hypotensive effects of organic nitrates; concomitant use is contraindicated.
Antihypertensives: possible additive hypotensive effects.
Aspirin: increased nitroglycerin levels. Tissue-type Plasminogen Activator (t-PA): decreased thrombolytic effect.
Heparin: anticoagulant effect of heparin may be reduced. Monitor APTT.
Ergotamine: increased bioavailability of ergotamine.
Alcohol: Additive vasodilatory effects to nitroglycerin. Consumption of alcohol should be avoided.
7.1 PDE5 Inhibitors
Phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil, vardenafil, and tadalafil have been shown to potentiate the hypotensive effects of organic nitrates. The time course of the interaction appears to be related to the half-life of the PDE5 inhibitor, however, the dose dependence of this interaction has not been studied. Use of nitroglycerin ointment, 0.4% within a few days of PDE5 inhibitors is contraindicated.
7.2 Antihypertensives
Patients receiving antihypertensive drugs, beta-adrenergic blockers, and other nitrates should be observed for possible additive hypotensive effects when using nitroglycerin ointment, 0.4%. Marked orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used concomitantly. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin ointment, 0.4% in patients with angina pectoris, additional hypotensive effects may occur.
7.3 Aspirin
Coadministration of aspirin (at doses between 500 mg and 1000 mg) and nitroglycerin has been reported to result in increased nitroglycerin maximum concentrations by as much as 67% and AUC by 73% when administered as a single dose. The pharmacological effects of nitroglycerin ointment, 0.4% may be enhanced by concomitant administration of aspirin.
7.4 Tissue-type
Plasminogen Activator (t-PA) Intravenous administration of nitroglycerin decreases the thrombolytic effect of tissue-type plasminogen activator (t-PA). Plasma levels of t-PA are reduced when coadministered with nitroglycerin. Therefore, caution should be observed in patients receiving nitroglycerin ointment, 0.4% during t-PA therapy.
7.5 Heparin
Although an interaction has been reported between intravenous heparin and intravenous nitroglycerin (resulting in a decrease in the anticoagulant effect of heparin), the data are not consistent. If patients are to receive intravenous heparin and nitroglycerin ointment, 0.4% concurrently, the anticoagulation status of the patient must be checked.
7.6 Ergotamine
Oral administration of nitroglycerin markedly decreases the first-pass metabolism of dihydroergotamine and consequently increases its oral bioavailability. Ergotamine is known to precipitate angina pectoris. Therefore the possibility of ergotism in patients receiving nitroglycerin ointment, 0.4% should be considered.
7.7 Alcohol
The vasodilating effects of nitroglycerin have been shown to be additive to the effects observed with alcohol.
Text above is quoted in full from the FDA-approved drug label published by openFDA, effective December 3, 2024. Matched to this product by RxNorm code. Cross-references to other sections of the full prescribing information have been removed, since they point to a document not shown here. Nothing else is changed: no sentence is shortened, reworded or summarised.
This page reproduces regulatory text for reference. It is not medical advice, and KenyRx is not a pharmacy or a prescriber. Talk to a doctor or pharmacist about whether a medicine is right for you.
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