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Amyl nitrite: Drug information

Amyl nitrite: Drug information
(For additional information see "Amyl nitrite: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Pharmacologic Category
  • Vasodilator
Dosing: Adult
Provocation of latent left ventricular outflow tract gradient in hypertrophic cardiomyopathy

Provocation of latent left ventricular outflow tract gradient in hypertrophic cardiomyopathy (off-label use): Nasal inhalation: 3 to 4 deep inhalations from 1 crushed ampul over a 10 to 15 second period (Ref). Note: The use of more physiologic testing (eg, Valsalva maneuver, treadmill testing with Doppler echocardiography) may be preferred over amyl nitrite inhalation (Ref).

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

Cardiovascular: Facial flushing, hypotension, orthostatic hypotension, syncope, tachycardia

Dermatologic: Diaphoresis, pallor

Gastrointestinal: Fecal incontinence, nausea, vomiting

Genitourinary: Urinary incontinence

Nervous system: Asthenia, cerebral ischemia, dizziness, headache, restlessness

Contraindications

Glaucoma; recent head trauma or cerebral hemorrhage; pregnancy.

Warnings/Precautions

Concerns related to adverse effects:

• Hypotension: Amyl nitrite may cause severe hypotension; serious adverse effects may occur at doses less than the recommended therapeutic dose. Monitor for adequate perfusion and oxygenation; ensure patient is euvolemic. Use with caution in patients with preexisting diminished oxygen or cardiovascular reserve (eg, anemia, substantial blood loss, cardiac or respiratory compromise) and in patients who may be susceptible to injury from vasodilation.

• Methemoglobinemia: Amyl nitrite may cause methemoglobin formation resulting in diminished oxygen-carrying capacity; serious adverse effects may occur at doses less than the recommended therapeutic dose. Monitor for adequate perfusion and oxygenation. Use with caution in patients with preexisting diminished oxygen or cardiovascular reserve (eg, anemia, substantial blood loss, cardiac or respiratory compromise) and in patients at greater risk for developing methemoglobinemia (eg, congenital methemoglobin reductase deficiency). Use with caution with concomitant medications known to cause methemoglobinemia (eg, nitroglycerin, phenazopyridine).

Disease-related concerns:

• Aortic stenosis: Use with extreme caution or avoid in patients with severe aortic stenosis; may reduce coronary perfusion resulting in ischemia; considered by some to be a contraindication (Wesley Reagan 2005).

• Cardiovascular disease: Use with caution in patients with coronary artery disease and patients with hypotension. Transient episodes of dizziness, weakness, syncope, and cerebral ischemia secondary to postural hypotension may occur.

• Increased intracranial pressure: Use with caution in patients with increased intracranial pressure; use is contraindicated in patient with recent head trauma or cerebral hemorrhage.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Liquid, for inhalation: USP: 85% to 103% (0.3 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Amyl Nitrite Inhalation)

0.3 mL (1): $0.63

Disclaimer: The pricing data provided represent a median AWP and/or AAWP price for the brand and/or generic product, respectively. The pricing data should be used for benchmarking purposes only, and as such should not be used to set or adjudicate any prices for charging or reimbursement functions. Pricing data is updated monthly.

Administration: Adult

Inhalation: Administer nasally via inhalation. The patient should be lying down during administration. Crush the ampul in a gauze pad and place in front of patient's mouth. One ampul lasts for ~3 minutes.

Use: Off-Label: Adult

Provocation of latent left ventricular outflow tract gradient in hypertrophic cardiomyopathy

Medication Safety Issues
High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs that have a heightened risk of causing significant patient harm when used in error.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. Risk D: Consider therapy modification

Amisulpride (Oral): May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy

Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Blood Pressure Lowering Agents: May enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination

Dapsone (Topical): May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Risk C: Monitor therapy

Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy

Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy

Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy

Local Anesthetics: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Local Anesthetics. Specifically, the risk for methemoglobinemia may be increased. Risk C: Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Nitric Oxide: May enhance the adverse/toxic effect of Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy

Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: Monitor therapy

Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Risk D: Consider therapy modification

Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy

Phosphodiesterase 5 Inhibitors: May enhance the vasodilatory effect of Amyl Nitrite. Risk X: Avoid combination

Prilocaine: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Prilocaine. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Management: Monitor patients for signs of methemoglobinemia (e.g., hypoxia, cyanosis) when prilocaine is used in combination with other agents associated with development of methemoglobinemia. Avoid lidocaine/prilocaine in infants receiving such agents. Risk C: Monitor therapy

Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Riociguat: Amyl Nitrite may enhance the hypotensive effect of Riociguat. Risk X: Avoid combination

Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy

Sodium Nitrite: Methemoglobinemia Associated Agents may enhance the adverse/toxic effect of Sodium Nitrite. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Risk C: Monitor therapy

Pregnancy Considerations

Amyl nitrite significantly decreases systemic BP and blood flow to the placenta. Amyl nitrite may also cause methemoglobin formation resulting in diminished oxygen-carrying capacity; fetal hemoglobin may be more susceptible to excessive nitrite-induced methemoglobinemia (Valenzuela 1986).

Use in pregnancy is contraindicated for indications in the FDA-approved product labeling.

Breastfeeding Considerations

It is not known if amyl nitrite is present in breast milk.

The manufacturer recommends that caution be exercised when administering amyl nitrite to breastfeeding women.

Monitoring Parameters

Monitor BP and heart rate during therapy.

Mechanism of Action

Relaxes vascular smooth muscle; decreases venous ratios and arterial BP; reduces left ventricular work; decreases myocardial O2 consumption.

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Within 30 seconds.

Duration: 3 to 15 minutes; Pharmacologic provocation of latent left ventricular outflow tract gradient in hypertrophic cardiomyopathy: ~30 seconds (Wesley Reagan 2005).

Absorption: Inhalation: Readily absorbed through respiratory tract.

Metabolism: In the liver to form inorganic nitrates (less potent).

Half-life elimination: Amyl nitrite: <1 hour; Methemoglobin: 1 hour.

Excretion: Urine (~33%).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (CZ) Czech Republic: Nitramyl;
  • (DE) Germany: Nitramyl;
  • (EE) Estonia: Amylnitrit;
  • (ES) Spain: Nitrito amilo;
  • (GB) United Kingdom: Amyl nitri;
  • (JP) Japan: Amyl nitrite afp | Amyl nitrite sankyo;
  • (LT) Lithuania: Nitramyl;
  • (PL) Poland: Nitramyl
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