Nitrates (Nitroglycerin)
Common brand names: Nitrostat, Nitro-Dur, Imdur, Isordil, Nitro-Bid
Two nutrients listed against this medication. The most severe is marked moderate.
At a glance
Neither of the two is marked well documented. Each row carries its own evidence level.
At a glance
- Thiamine (Vitamin B1)Moderate · Traditionally cited, limited evidence
- SeleniumMild · Traditionally cited, limited evidence
Color shows how serious each listed effect is. The label beside it shows how strong the evidence is. The cards below explain each one and show its evidence.
Nutrients it can lower
Mechanism, Nitrate tolerance is driven by vascular oxidative stress. Selenium-dependent glutathione peroxidase is part of the antioxidant defense that ALDH2-mediated nitroglycerin bioactivation depends on, which is the basis of the proposed link. Whether nitrates deplete selenium has never been measured; the direction of any relationship is unestablished.
Common signs, Nitrate tolerance (drug stops working), oxidative stress, immune suppression, thyroid dysfunction
Münzel et al. (J Clin Invest, 1995): nitrate-tolerant vessels showed enhanced superoxide anion production, establishing tolerance as an oxidative-stress mechanism. That is not selenium depletion, and no study has measured selenium status on nitrate therapy.
Selenium 100–200 mcg daily as selenomethionine is a range in common use, not from a trial cited on this row. The cited paper measured vascular superoxide production in nitrate tolerance and studied no selenium. 400 mcg/day is the tolerable upper intake level.
Mechanism, Many nitrate users have heart failure with concurrent diuretic therapy, which depletes thiamine. Thiamine deficiency causes wet beriberi, a form of heart failure clinically indistinguishable from worsening cardiac disease.
Common signs, Worsening heart failure, edema, peripheral neuropathy, fatigue, confusion
The cited thiamine data concern furosemide, a different drug; there is no nitrate–thiamine depletion evidence.
Benfotiamine 150–300 mg daily is a figure in common use, not from a trial cited on this row. The thiamine data concern furosemide, a different drug, and no cited trial compared benfotiamine with thiamine.
For your next appointment
It prints or saves as a single page. Whether to add a supplement for a nutrient this medication may lower is a decision for your prescriber.
Disclosure
These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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