Nitrolingual Drug Interactions

Concomitant intake of other vasodilators, antihypertensives, β-blockers, calcium antagonists, neuroleptics or tricyclic antidepressants and alcohol may potentiate the antihypertensive effect of Nitrolingual Spray. Concomitant intake of nitric oxide donors (e.g. Nitrolingual Spray) and certain drugs (phosphodiesterase inhibitors) for the treatment of erectile dysfunction or pulmonary arterial hypertension enhances the hypotensive effect. Therefore the concomitant administration of nitric oxide donors, e.g. the active ingredient of Nitrolingual Spray, and these drugs is contraindicated (see Contraindications).
If a patient treated with these drugs for erectile dysfunction or pulmonary arterial hypertension needs a rapidly effective nitrate (e.g. in case of an acute angina pectoris attack) he/she must be closely monitored. In patients previously treated with organic nitrates (e.g. isosorbide dinitrate, isosorbide-5-mononitrate) it may be necessary to increase the glyceryl trinitrate dose to achieve the desired effect. If used concomitantly with dihydroergotamine, Nitrolingual Spray may increase the DHE level and consequently enhance its hypertensive effect. Concomitant administration of heparin and glyceryl trinitrate weakens the effect of heparin.