硝酸異山梨酯 / 單硝酸異山梨酯

用途

• Adjunctive treatment of heart failure associated with thyroid storm
• Refractory heart failure or in combination with hydralazine or amlodipine in patients unable to tolerate ACE inhibitors
• Refractory heart failure or in combination with hydralazine or amlodipine in patients unable to tolerate ACE inhibitors

給藥方式

可能的副作用

• Postural hypotension
• Reflex tachycardia
• Lethargy or weakness (secondary to hypotension)
• Gastrointestinal upset
• Restlessness
• Headache (well-documented in humans, difficult to assess in animals)
• Hypersensitivity reactions (rare)

注意事項與禁忌

• Cardiogenic or hypovolemic shock
• Severe hypotension
• Hypovolemia
• Use as a sole agent for treating heart failure
• Concurrent use with selective phosphodiesterase inhibitors (e.g., sildenafil)
• > **Hemodynamic Warning:** Use with extreme caution in patients with low blood pressure or uncorrected hypovolemia. * **Nitrate Tolerance:** Continuous exposure may lead to tolerance. Consider dosing strategies that allow for a nitrate-free interval if chronic use is intended. * **Laboratory Interference:** Serum cholesterol levels may be falsely decreased by nitrates when using the Zlatkis-Zak color reaction method. * **Pregnancy:** FDA Category C. Use only if the potential benefit justifies the potential risk to the fetus.

藥物相互作用

• Antihypertensive Drugs (e.g., ACE inhibitors, amlodipine, beta-blockers): Possible additive hypotensive effects; monitor blood pressure closely.
• Phenothiazines (e.g., acepromazine): Possible additive hypotensive effects due to alpha-adrenergic blockade.
• Selective Phosphodiesterase Inhibitors (e.g., sildenafil, pimobendan): Concurrent use with sildenafil can cause profound, life-threatening hypotension and is strictly contraindicated. Use with pimobendan (a PDE3 inhibitor) is common in vet med but requires monitoring for excessive vasodilation.

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