amyl nitrite (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

liquid for inhalation

  • 0.3 mL (0.85-103%) crushable glass ampule

Acute Relief of Angina

0.3 mL by inhalation of crushed ampule, may repeat q3-5min

Wave crushed ampule under nose multiple times for 2-6 nasal inhalations

Cyanide Poisoning

0.3 mL ampule crushed and contents poured onto a gauze and placed in front of patient's mouth or endotracheal tube, if patient intubated, to inhale over 15-30 sec; repeat qMin until IV sodium nitrite available

Each ampul lasts ~3 min; separate administration by at least 30 sec to allow patient to adequate oxygenate

Dosage Forms & Strengths

liquid for inhalation

  • 0.3 mL (0.85-103%) crushable glass ampule

Angina Pectoris

Safety & efficacy not established

Cyanide Poisoning (Off-label)

0.3 mL ampule crushed and contents poured onto a gauze and placed in front of patient's mouth or endotracheal tube if patient intubated to inhale over 15-30 sec; repeat qMin until IV sodium nitrite available

Each ampul lasts ~3 min; separate administration by at least 30 sec to allow patient to adequate oxygenate

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Interactions

Interaction Checker

and amyl nitrite

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Contraindicated (1)

            • riociguat

              amyl nitrite, riociguat. Either increases effects of the other by additive vasodilation. Contraindicated. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension.

            Serious - Use Alternative (9)

            • avanafil

              amyl nitrite, avanafil. Either increases effects of the other by Mechanism: additive vasodilation. Avoid or Use Alternate Drug. Potentially fatal hypotension.

            • cabergoline

              amyl nitrite increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • ergoloid mesylates

              amyl nitrite increases effects of ergoloid mesylates by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • ergotamine

              amyl nitrite increases effects of ergotamine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • lofexidine

              lofexidine, amyl nitrite. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

            • methylergonovine

              amyl nitrite increases effects of methylergonovine by decreasing metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris.

            • sildenafil

              amyl nitrite, sildenafil. Mechanism: additive vasodilation. Avoid or Use Alternate Drug. Potentially fatal hypotension.

            • tadalafil

              amyl nitrite, tadalafil. Mechanism: additive vasodilation. Avoid or Use Alternate Drug. Contraindicated. Potentially fatal hypotension. Allow 48h after last tadalafil dose before nitrate administration.

            • vardenafil

              amyl nitrite, vardenafil. Mechanism: additive vasodilation. Avoid or Use Alternate Drug. Potentially fatal hypotension.

            Monitor Closely (8)

            • arginine

              amyl nitrite, arginine. Mechanism: additive vasodilation. Use Caution/Monitor. Possible hypotension.

            • benazepril

              amyl nitrite, benazepril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increases risk of hypotension.

            • bretylium

              amyl nitrite, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

            • bupivacaine implant

              amyl nitrite, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.

            • captopril

              amyl nitrite, captopril. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure. Monitor blood pressure.

            • dapsone topical

              amyl nitrite increases toxicity of dapsone topical by altering metabolism. Modify Therapy/Monitor Closely. May induce methemoglobinemia.

            • nitroglycerin rectal

              nitroglycerin rectal, amyl nitrite. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .

            • tetracaine

              tetracaine, amyl nitrite. Other (see comment). Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered.

            Minor (0)

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              Adverse Effects

              Frequency Not Defined

              Common

              • Dizziness
              • Facial flushing
              • Hypotension
              • Tachycardia
              • Vasodilation
              • Headache restlessness
              • Syncope
              • Shock
              • Nausea, vomiting
              • IOP increased
              • Orthostatic hypotension

              Less Common

              • Hemolytic anemia
              • Methemoglobulinemia (high dose)
              • Rash
              • Weakness
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              Warnings

              Contraindications

              Hypersensitivity to organic nitrates

              Recent use (last 24 hr) sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) or other phopsphodiesterase-5 inhibitor use

              Caution in narrow angle glaucoma (controversial: may not be clinically significant)

              Severe anemia

              Recent head trauma

              Cautions

              AMI, alcohol use, hyperthyroidism, cardiomyopathy, incr ICP (eg, head, trauma, cerebral hemorrhage-potential contraindication), incr IOP, postural hypotension, volume depletion, low systolic BP

              Inability to relieve chest pain after 3 doses may mean AMI-rush to ER if possible

              Avoid excessive, prolonged hypotension

              Withdraw gradually to avoid acute angina

              Patient should be sitting down during & immediately after inhaling

              Do not change brands unintentionally as not all are bioequivalent

              Treat drug-induced headache with aspirin or acetaminophen

              Provide nitrate-free interval (10-12 hr or overnight) to avoid development of tolerance

              Protect from light

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              Pregnancy & Lactation

              Pregnancy Category: C (X for angina)

              Lactation: Use caution; not known whether drug crosses into breast milk

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Vasodilating agent

              Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, and myocardial O2 demand

              Also improve coronary collateral circulation. Lower BP, incr HR, occasional paradoxical bradycardia

              Cyanide Poisoning: Nitrite ions react with hemoglobin to form methemoglobin which unites with cyanide to form cyanomethemoglobin; this causes cytochrome oxidase to become free, which in turn allows aerobic metabolism to continue

              Pharmacokinetics

              Onset: 10-30 sec

              Duration: 3-15 min (angina)

              Peak: 3 min

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              Images

              No images available for this drug.
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              Patient Handout

              Patient Education
              amyl nitrite inhalation

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.