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Headache (nitrate-induced headache) is common at the start of the treatment. Experience has shown that this usually subsides as administration of the substance is continued.
A decline in the blood pressure and/or orthostatic hypotension have occasionally been observed when the substance is first used, and also when the dose is increased. These may be associated with a reflex increase in the heart rate, drowsiness and a sensation of dizziness and weakness.
Nausea, vomiting, transient reddening of the skin (flush) and allergic cutaneous reactions may occur in rare cases.
Collapse states are observed in rare cases, occasionally with bradycardial disturbances of heart rhythm, and syncope.
Exfoliative dermatitis may occur in individual cases.
In rare cases, a pronounced decline in the blood pressure may be linked to increase severity of the symptoms of angina pectoris.
Tolerance development and the occurrence of cross tolerance to other nitro compounds have been described. Attenuation of the haemodynamic effects has been observed within 24 hours, even during continuous administration.
Even when used as directed, this drug may alter the reactions to such an extent that the ability to drive or operate machinery is impaired. This applies in particular when the effects are combined with alcohol.
