Nitroglycerin is the most common nitrate used in the treatment of heart attacks. It can be given sublingually (under the tongue), as a spray, as a paste applied over skin, and intravenously. Intravenous nitroglycerine has a rapid onset of action and is commonly used in the initial (first 48 hours) treatment of heart attacks. Nitroglycerine is a vasodilator (blood vessel dilator), which opens arteries by relaxing the muscular wall of the artery. Nitroglycerine dilates coronary arteries as well as other blood vessels throughout the body. By dilating blood vessels, nitroglycerine lowers blood pressure, decreases the work that the heart must do, lowers the demand by the heart for oxygen, prevents coronary artery spasm, improves blood flow to the heart muscle, and potentially minimizes the size of the heart attack. Nitroglycerine is especially helpful in patients with heart attacks who also have heart failure or high blood pressure.
The common side effects of nitrates are headaches and low blood pressure. Low blood pressure can cause weakness, dizziness, and, sometimes, even fainting. Nitrates should not be given in patients who have taken medicines for erectile dysfunction such as sildenafil (Viagra) and vardenafil (Levitra) in the preceding 24 hours, since severe low blood pressure may result. Nitrates should not be given in patients who have taken tadalafil (Cialis) in the preceding 36-48 hours because the effects of Cialis last longer than either sildenafil or vardenafil .
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