What’s the problem with nitrate administration?

Nitrates refer to a group of compounds that contain nitrogen and oxygen atoms in various forms. They are often used as medications to manage and prevent angina symptoms, a condition characterized by chest pain or discomfort. Angina occurs when the heart muscles receive an insufficient amount of oxygen due to narrowed or blocked blood vessels.

Nitrates stimulate the production of a molecule called nitric oxide (NO) in blood vessels. Nitric oxide induces vasodilation, a process that widens the diameter of blood vessels, improving blood flow and reducing the workload of the heart. Nitrates are available in different forms such as sublingual tablets, patches, sprays, and ointments, and usually, provide fast relief from angina symptoms. However, the administration of nitrates is not without risks and potential side effects.

Factors that Contribute to Nitrate Intolerance

Nitrates should be used with caution, particularly for people with certain medical conditions or taking specific medications that can interact with nitrates. Some of the factors that may contribute to nitrate intolerance include:

1. Hypotension

Hypotension refers to low blood pressure. Nitrates can significantly lower blood pressure, leading to dizziness, light-headedness, or fainting. People who have hypotension should avoid using nitrates or use them with caution under close medical supervision.

2. Allergic Reactions

Skin rash, itching, hives, and difficulty breathing are some of the signs and symptoms of allergic reactions to nitrates. Individuals who have previously experienced an allergic reaction to nitrates or any of its components should not use nitrates until they seek medical advice.

3. Medications that Interact with Nitrates

Certain medications, including erectile dysfunction drugs, blood pressure medications such as alpha-blockers, and combinations of prescription medications and over-the-counter products that contain nitrates or nitrites, can interact with nitrates and cause severe and sudden drops in blood pressure. Health providers should be informed of any medications or supplements that an individual is taking before prescribing nitrates.

4. Previous Head Injuries

The administration of nitrates should be avoided in individuals who recently experienced head injuries or have brain problems due to the risk of intracranial bleeding.

Side Effects of Nitrate Administration

Nitrates can cause mild to severe side effects, depending on individual factors such as the length of treatment, type of nitrate, and dose. Some of the possible side effects of nitrate administration include:

1. Headaches

Headaches are the most common side effect of nitrates, occurring in up to 50% of people using nitrates. The headaches are usually moderate to severe and appear a few hours after the administration of the drug. The severity of headaches often improves with prolonged use of nitrates as the body adjusts to the medication.

2. Flushing and Spontaneous Sweating

Flushing and spontaneous sweating are common side effects of nitrates, particularly when used in high doses. This is because nitrates increase blood flow to the skin, leading to redness and warmth in the face, neck, or chest. Some people may also experience dizziness and fainting related to these symptoms.

3. Nausea and Vomiting

About 20% of people using nitrates may experience mild symptoms of nausea, vomiting, or stomach upset. These symptoms are usually mild and resolve on their own after a few days of continued use of nitrates.

4. Methemoglobinemia

Methemoglobinemia is a rare but potentially serious side effect of nitrates that can occur when the drug is used in high doses or for prolonged periods. Methemoglobin is a type of hemoglobin that cannot bind and deliver oxygen effectively to the body tissues, leading to shortness of breath, fatigue, and bluish discoloration of the skin and nails. Methemoglobinemia requires immediate medical attention.


Nitrates are effective medications for managing acute and chronic angina symptoms. However, the administration of nitrates requires careful consideration of medical history, drug interactions, and potential side effects to minimize the risk of complications. People using nitrates or who are considering starting the medication should consult with their healthcare providers for guidance.


Common Questions on Nitrate Administration

  • What are the common types of nitrates used for angina treatment? The common types of nitrates used for angina treatment include sublingual tablets, sprays, patches, and ointments, which are absorbed through the mouth, skin, or lungs.
  • What is the dosage for nitrates? The dosage for nitrates varies depending on the type of nitrate and the severity of the angina symptoms. Healthcare providers usually prescribe the lowest effective dose and titrate the dose as needed to achieve optimal symptom relief.
  • Can nitrates be used for people with heart failure? Nitrates are generally avoided in people with heart failure due to the risk of hypotension and further worsening of heart function. However, individual factors such as the severity of symptoms and response to other medications should be considered before making the decision to use or avoid nitrates.
  • How long does the effect of nitrates last? The effect of nitrates usually lasts from 20 minutes to a few hours depending on the type of nitrate used.
  • Can nitrates be used during pregnancy or breastfeeding? Nitrates are generally avoided during pregnancy and breastfeeding due to potential effects on fetal and infant health. However, the use of nitrates may be warranted in some cases where the benefits outweigh the risks, and close monitoring is provided by healthcare providers.

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