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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      Serious - Use Alternative

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          Minor

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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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            Formulary

            FormularyPatient Discounts

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            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.