Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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)
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
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
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.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
Images
Patient Handout
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) 2023 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.
Formulary
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