Nitrolingual Drug Interactions

Exercise caution in patients who are taking/using, have recently taken/used or might take/use any other medicines, including medicines available without a prescription.
Nitrolingual Spray lowers the blood pressure. This effect is increased when used together with the following medicines: other vasodilators (medicines that widen the blood vessels); medicines for high blood pressure (e.g. beta-receptor blockers, calcium antagonists, water tablets (diuretics), ACE inhibitors); medicines for mental illness such as depression (tricyclic antidepressants) or psychosis (neuroleptics); alcohol; sapropterin, an active substance used to treat hyperphenylalaninaemia; phosphodiesterase-5 inhibitors (e.g. sildenafil, vardenafil or similar products) for the treatment of erection problems (erectile dysfunction) or certain disorders of the blood vessels in the lung (pulmonary arterial hypertension).
Patients treated with phosphodiesterase-5 inhibitors and requiring an acute nitrate (such as Nitrolingual Spray) for an acute angina attack should be promptly hospitalised in advance.
N-acetylcysteine can enhance the vasodilatory effect of Nitrolingual Spray.
In patients who have previously been treated with organic nitrates, e.g. isosorbide dinitrate, isosorbide-5-mononitrate, a higher dosage of glyceryl trinitrate may be required to achieve the desired effect on the blood circulation.
Nitrolingual Spray can, if used at the same time as dihydroergotamine (a medicine used to treat migraine), lead to a rise in the DHE level, thereby enhancing its effect on increasing the blood pressure.
Heparin will become less effective if used at the same time as Nitrolingual Spray. The heparin dose must be adjusted accordingly, together with close monitoring of blood clotting parameters. After discontinuing glyceryl trinitrate, blood clotting may become significantly reduced (massive rise in PTT) and a reduction in the heparin dose may therefore be required.