From the Guidelines
Morphine and nitroglycerin can be given together in certain clinical scenarios, but with caution and close monitoring of the patient's blood pressure. When considering the administration of morphine and nitroglycerin together, it is essential to weigh the potential benefits against the risks, particularly in patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) 1. The 2014 AHA/ACC guideline for the management of patients with NSTE-ACS suggests that morphine sulfate may be administered during intravenous nitroglycerin therapy with blood pressure monitoring 1. Key points to consider when administering morphine and nitroglycerin together include:
- Morphine dose: 1 mg to 5 mg IV, which may be repeated every 5 to 30 minutes to relieve symptoms and maintain the patient’s comfort 1.
- Blood pressure monitoring: essential to avoid hypotension, a potential side effect of both morphine and nitroglycerin 1.
- Clinical scenario: patients with symptoms despite antianginal treatment, where morphine and nitroglycerin may be beneficial in reducing ischemic pain and improving hemodynamics 1. It is crucial to note that the decision to administer morphine and nitroglycerin together should be made on a case-by-case basis, taking into account the individual patient's clinical presentation, medical history, and potential risks 1.
From the FDA Drug Label
Administration of nitroglycerin sublingual tablets are contraindicated in patients who are using a phosphodiesterase-5 (PDE-5) inhibitor (e.g., sildenafil citrate, tadalafil, vardenafil hydrochloride) since these compounds have been shown to potentiate the hypotensive effects of organic nitrates. The answer to the question of giving undue (likely a typo, possibly meaning Viagra, sildenafil) and nitroglycerin together is:
- No, they should not be given together, as concomitant use can cause hypotension 2.
From the Research
Combination Therapy for Angina
- The provided studies do not directly address the combination of undue and nitroglycerin, but rather discuss various treatments for angina pectoris, including nitrates, beta-blockers, and calcium channel blockers.
- According to 3, nitroglycerin and long-acting nitrates are effective antianginal agents, but nitrate tolerance can be a major drawback to chronic therapy.
- The study 4 discusses the use of calcium channel blockers in angina, stating that they can be used in combination with nitrates and beta blockers, but with certain precautions.
- Another study 5 examines the combination of calcium-channel blockers and beta blockers in chronic stable angina pectoris, suggesting that nifedipine can be safely combined with beta-adrenergic blockers.
- More recent studies, such as 6, continue to recommend beta-blockers and calcium channel blockers as first-line therapies for stable coronary ischemic disease.
- A recent review 7 discusses the potential benefits of compound Danshen dripping pills as a complementary therapy for stable angina pectoris, but does not address the specific combination of undue and nitroglycerin.
Safety and Efficacy
- The studies emphasize the importance of carefully designed dosing regimens and appropriate use of nitrate formulations to decrease or eliminate the problem of nitrate tolerance 3.
- They also highlight the need for detailed knowledge of each drug and its potential interactions when used in combination therapy 4, 5.
- The safety and efficacy of combination therapies, including those involving nitrates, beta-blockers, and calcium channel blockers, are discussed in the context of chronic stable angina pectoris 5, 6.