What is nitroglycerin? How does it interact with other drugs?

N-acetylcysteine (NAC)

Effect: Possible Benefits and Risks

NAC is a specially modified form of the dietary amino acid cysteine that has
various proposed uses. Nitrates such as nitroglycerin lose some of their
effectiveness over time. According to some studies, the supplement
N-acetylcysteine might help these drugs work better.
However, the combination of NAC and nitroglycerin appears to cause severe
headaches.

Taking NAC with nitroglycerin may be beneficial in some cases. However, unpleasant
side effects probably limit the use of this combination.

Angina is too serious a disease for self-treatment. Persons
with angina should not take any supplement except on a physician’s advice.

Vitamin C

Effect: Supplementation Possibly Helpful

Vitamin
C may help prevent the development of tolerance to nitrate
medications such as nitroglycerin. According to a double-blind study of
forty-eight persons, the use of vitamin C at a dose of 2,000 milligrams (mg) three
times daily helped maintain the effectiveness of nitroglycerin. These findings are
supported by other studies.

Angina is too serious a disease for self-treatment. Persons with angina should not take any supplement except on a physician’s advice.

Arginine

Effect: Supplementation Possibly Helpful

According to a small, double-blind, placebo-controlled crossover study, the use of
arginine (700 mg four times daily) may help prevent
tolerance to nitrate medications.

Folate

Effect: Supplementation Possibly Helpful

A small, double-blind trial suggests that folate
supplements (at the high dose of 10 mg daily) may help prevent tolerance to
nitrate medications.

Vitamin E

Effect: Supplementation Possibly Helpful

A small, double-blind trial suggests that vitamin E at
a dose of 200 mg three times daily may help prevent tolerance to nitrate
medications.

Bibliography

Bassenge, E., et al. “Dietary Supplement with Vitamin C Prevents Nitrate Tolerance.” Journal of Clinical Investigation 31 (1998): 67-71.

Daniel, T. A., and J. J. Nawarskas. “Vitamin C in the Prevention of Nitrate Tolerance.” Annals of Pharmacotherapy 4 (2000): 1193-1197.

Gori, T., et al. “Folic Acid Prevents Nitroglycerin-Induced Nitric Oxide Synthase Dysfunction and Nitrate Tolerance: A Human In Vivo Study.” Circulation 104 (2001): 1119-1123.

McVeigh, G. E., et al. “Platelet Nitric Oxide and Superoxide Release During the Development of Nitrate Tolerance: Effect of Supplemental Ascorbate.” Circulation 106 (2002): 208-213.

Parker, J. O., et al. “The Effect of Supplemental L-arginine on Tolerance Development During Continuous Transdermal Nitroglycerin Therapy.” Journal of the American College of Cardiology 39 (2002): 1199-1203.

Watanabe, H., et al. “Randomized, Double-Blind, Placebo-Controlled Study of the Preventive Effect of Supplemental Oral Vitamin C on Attenuation of Development of Nitrate Tolerance.” Journal of the American College of Cardiology 31 (1998): 1323-1329.