Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction

-    Consistent with their known effects on the nitric oxide/cyclic guanosine monophosphate (cGMP) pathway, phosphodiesterase type 5 inhibitors (e.g. sildenafil, vardenafil and tadalafil) have been shown to potentiate the hypotensive effects of nitrates. A severe and possibly dangerous fall in blood pressure may occur. This can result in collapse, unconsciousness and paradoxical myocardial ischaemia and may be fatal. Such use is therefore contra- indicated (section 4.3).
If a patient treated with these drugs for erectile dysfunction or pulmonary arterial hypertension needs a rapidly effective nitrate, he/she should be closely monitored.
-    Treatment with other agents with hypotensive effects (e.g. vasodilators, antihypertensives, diuretics, beta-blockers, calcium channel blockers and neuroleptics, tricyclic antidepressants and sapropterin) may potentiate the hypotensive effect of glyceryl trinitrate. In addition to these agents, the risk of hypotension and syncope with use of glyceryl trinitrate may be enhanced by alcohol.
-    N-acetylcysteine may potentiate the vasodilator effects of glyceryl trinitrate.
The possibility of tolerance to the effects of glyceryl trinitrate should be considered when used in conjunction with long- acting nitrate preparations.
-    There is evidence that systemic nitrates may interfere with the anticoagulant effects of heparin. Early and frequent monitoring of anticoagulation is recommended when systemic nitrates and heparin are used in combination.
During the simultaneous use of dihydroergotamine, glyceryl trinitrate may lead to an increase in the DHE level and thus potentiate its hypertensive action.