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| Interactions: | Aspirin Adverse Effect: an increase in nitroglycerin concentrations and additive platelet function depression
Clinical Management: This interaction may be used therapeutically to benefit patients with acute myocardial infarction (AMI). In the non-AMI patient taking analgesic doses of aspirin, monitor for an exaggerated response to nitroglycerin, as evidenced by headache and syncope. An alternative analgesic may be considered.
FluphenazineIncreased risk of postural hypotension
Heparin Adverse Effect: decreased anticoagulant effectiveness
Clinical Management: In patients who are being anticoagulated with heparin, the addition of intravenous nitroglycerin may result in subtherapeutic levels of anticoagulation. This effect should be anticipated and may require an increased heparin infusion rate with or without a heparin bolus. Partial thromboplastin times should be assessed with the initiation and withdrawal of cotherapy and at regular intervals thereafter to ensure adequate anticoagulant response.
Indomethacin Adverse Effect: decreased coronary blood flow
Levodopa Increased risk of postural hypotension
Nicorandil Increased hypotensive effects
Pancuronium Adverse Effect: an increase in pancuronium duration of action
Clinical Management: Concurrent administration of nitroglycerin and pancuronium is not recommended. If concurrent use cannot be avoided, carefully titrate the dose of the neuromuscular blocking agent and monitor for increased or prolonged respiratory depression or paralysis (apnea).
Rtpa Adverse Effect: less coronary artery reperfusion, longer time to reperfusion, and more coronary artery reocclusion
Clinical Management: Concomitant use of nitroglycerin and alteplase should be avoided if possible. If coadministration is necessary, the lowest effective dose of nitroglycerin should be used. Be aware that alteplase efficacy may be decreased and the risk of reocclusion may be increased.
ThioridazineIncreased risk of postural hypotension
TrifluoperazineIncreased risk of postural hypotension |
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