Adverse effects

• Circulatory dysregulation: hypotension, reflex sympathetic activity → reflex tachycardia → nitrate syncope
  • Beta blockers can be applied to counter this mechanism
• Nitrate-induced headache (due to the dilation of the cerebral arteries)
• Development of tolerance
  • Prevention: intermittent therapy with nitrate-free intervals of at least 8 hours
  • Usually the nitrate-free period is timed to occur during the night when the patient is sleeping and cardiac work is the least.
• Cyanide toxicity after sodium nitroprusside infusion (see cyanide poisoning)