Pharmacologically Relevant Drug Interactions of Nitrovasodilators

Nitrovasodilators are used to treat many conditions including coronary artery disease, chronic congestive heart failure, and arterial hypertension. They induce smooth muscle relaxation by increasing intracellular cyclic Guanosine Monophosphate (cGMP) concentrations and activating K+ channels through the release of Nitric Oxide (NO). Thus, they could interact with the drugs preventing the breakdown or increasing the synthesis of cGMP and induce the accumulation of cGMP resulting in excessive vasodilation and severe hypotension. Pharmacologically relevant drug interactions of Nitrovasodilators are discussed in this review. Coadministration of Nitrovasodilators and the drugs preventing the breakdown of cGMP like Phosphodiesterase 5 (PDE5) inhibitors or the drugs increasing the synthesis of cGMP like Riociguat could induce the accumulation of cGMP resulting in excessive vasodilation and severe hypotension. The prescribers and pharmacists are required to be aware of the drugs interacting with Nitrates to predict and prevent the adverse drug interactions.