Glyceryl trinitrate Heparin

Glyceryl trinitrate overdose should be treated with the patient s head lowered. Other measures include respiration maintenance, use of plasma expanders, and electrolyte balance. Withdrawal of heparin treatment or dose reduction should be performed with the overdose of heparin. Protamine sulfate may be used to reduce severe bleeding. Heparin should be used with caution with glyceryl trinitrate, aprotinine, alcohol, tobacco, and ACE inhibitors. Nifedipine should be used with care when coadministering with immunosuppressants, magnesium salts, tobacco, digoxin, antineoplastics, calcium channel blockers, antihistamines, antifungals, antiepileptics, antiarrhythmics, and alcohol. 

Resistance to heparin has been observed in patients in coronary care units receiving intravenous glyceryl trinitrate. Although this has been imputed to propylene glycol in glyceryl trinitrate formulations (113), resistance has also been described with propylene glycol-free... 

There have been reports of heparin resistance associated with glyceryl trinitrate (105) (SEDA-16, 196), but subsequent review of this interaction showed no clinical relevance, provided that heparin anticoagulation is monitored closely (106,107). 

The effects of heparin were reduced by the infusion of glyceryl trinitrate in some studies, but other studies have failed to confirm this interaction. On balance, the evidence favours there being no clinically important interaction. No interaction has been seen with heparin and isosorbide dinitrate or molsidomine. 

Not understood. One study suggests that what occurs is related to a glyceryl trinitrate-induced antithrombin III abnormality, and is apparent at doses above 350 micrograms/minute. One study found that heparin levels were lowered, whereas another reported unchanged heparin levels. ... 

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