Nitrate adverse effects

Erythrityl is readily absorbed from the GI tract. It undergoes extensive first-pass metaboHsm ia the Hver by glutathione organic nitrate reductase. Time to onset of effect is 5—10 min by subHngual adrninistration and 20—30 min when swallowed. The duration of effects for the two routes ate up to 3 and 6 h, respectively. Adverse effects are similar to those described for nitroglycerin (99). 

Substances which have an adverse effect on the oxygen balance, particularly ammonia, nitrates The following metalloids and metals and their compounds ... 

The acute adverse effects of the organic nitrates as well as molsidomine are directly related to their therapeutic vasodilation as they can cause orthostatic hypotension, tachycardia and throbbing headache. 

Attention has been given to possible adverse effects of incorporating tert-butyl methyl ether into antomobile fuels. tert-Butyl formate is an established product of photolysis, and it has been shown that photolysis in the presence of NO can produce the relatively stable tert-butoxyformyl peroxynitrate. This has a stability comparable to that of peroxy-acetyl nitrate, and may therefore increase the potential for disseminating NO (Kirchner et al. 1997). 

Common adverse effects of nitrates include postural hypotension, flushing, and headache secondary to venodilation. Headache often resolves with continued therapy and may be treated with acetaminophen. Hypotension is generally... 

Nitrates have been suggested in patients who do not achieve therapeutic goals (heart rate reduction) with P-blocker therapy alone. Trials to evaluate the effects of nitrates (e.g., isosorbide mononitrate) on portal pressure, both alone and in combination with P-blockers, show enhanced reduction of portal pressure however, there is an increase in mortality when nitrates are used alone. Adverse effects are significantly higher in patients treated with the combination of non-selective P-blockers and nitrates as opposed to P-blocker monotherapy.42,43 Unfortunately,... 

The most significant adverse effects of nitrates are tachycardia, flushing, headache, and hypotension. Nitrates are contraindicated in patients who... 

Because calcium channel antagonists may be more effective, have few serious adverse effects, and can be given less frequently than nitrates, some authorities consider them the agents of choice for variant angina. Nifedipine, verapamil, and diltiazem are all equally effective as single agents for... 

Monitoring for major adverse effects should be undertaken they include headache and dizziness with nitrates fatigue and lassitude with /J-blockers and peripheral edema, constipation, and dizziness with calcium channel antagonists. 

Sildenafil and vardenafil decrease systolic/diastolic blood pressure by 8 to 10/5 to 6 mm Hg for 1 to 4 hours after a dose. Although most patients are asymptomatic, multiple antihypertensives, nitrates, and baseline hypotension increase the risk of developing adverse effects. Although tadalafil does not decrease blood pressure, it should be used with caution in patients with cardiovascular disease because of the inherent risk associated with sexual activity. 

Gn Pig = guinea pig Hemato = hematological LOAEL = lowest-observed-adverse-effect level Musc/skel = muscular/skeletal NOAEL = no-observed-adverse-effect level RBC = red blood cell Resp = respiratory TF4 = thorium tetraf1uoride ThN03 = thorium nitrate Th02 = thorium dioxide. 

Derm = dermal LOAEL = lowest-observed-adverse-effect level NOAEL = no-observed-adverse-effect level ThN03 thorium nitrate. 

---