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Patients should consult their physician before taking any other medication (either prescription or over-the-counter), nutritional supplements or herbal extracts. Of particular concern to patients taking nitrates are:
- Heart medications. These include other vasodilators, antihypertensives (drugs that treat high blood pressure) and antiarrhythmics (drugs that treat irregular heart rates). In combination with nitrates, these medications could produce a severe drop in blood pressure (hypotension).
- Erectile dysfunction medications (e.g., Viagra). These can increase the effects of nitrates on blood pressure, causing severe low pressure blood or cardiac arrest.
- Alcohol. Drinking alcoholic beverages could also produce a severe drop in blood pressure. Patients taking nitrates should abstain from alcohol use.
- Grapefruit juice. Grapefruit juice interferes with the liver’s ability to rid the body of some substances. This could lead to a buildup of nitrates to toxic levels in the body. Though the buildup is less likely if the juice is ingested four or more hours prior to the medicine, patients taking nitrates are advised to refrain from drinking grapefruit juice. Patients may also be instructed to avoid eating grapefruit.
- Other substances. Using nicotine, marijuana or cocaine will reduce the effectiveness of nitrates.
Finally, a genetic anomaly found in up to 50 percent of people of Asian descent means that this population may not respond to nitrates. | 
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