Drug Interactions:
Nitroglycerin

Trade Names
  • Deponit, Minitran, Nitrek, Nitro-Bid, Nitro-Derm, Nitro-Dur, Nitro-Time, Nitrocine, Nitrodisc, Nitrogard, Nitroglyn, Nitrol, Nitrolingual, Nitrong, NitroQuick, Nitrostat, Transderm-Nitro

Nitroglycerin (NTG) is one of the most commonly used treatments for quick relief of anginal pain. Related drugs include isosorbide dinitrate and isosorbide mononitrate.

N-Acetyl Cysteine (NAC)

Possible Benefits and Risks

N-acetyl cysteine (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,^1,2 but not all,^3,4 the supplement N-acetyl cysteine might help these drugs work better. However, there's a catch: the combination of NAC and nitroglycerin appears to cause severe headaches.^5,6

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

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.

Vitamin C

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 48 individuals, use of vitamin C at a dose of 2000 mg three times daily helped maintain the effectiveness of nitroglycerin.¹⁰ These findings are supported by other studies as well.^9,13,14

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.

Arginine

Supplementation Possibly Helpful

According to a small, double-blind, placebo-controlled crossover study, use of arginine (700 mg four times daily) may help prevent tolerance to nitrate medications.¹⁵

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on physician’s advice.

Folate

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.¹¹

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.

Vitamin E

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.¹²

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.

Last reviewed August 2002 by Medical Review Board

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