NutriStack
NAC and Nitroglycerin, a caution.
NAC can potentiate nitroglycerin-related vasodilation and headache. In people using nitrates for angina, this may increase the chance of symptomatic hypotension, dizziness, severe headache, or fainting.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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What the row says.
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At a glance
- Substances
- NAC and Nitroglycerin
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. NAC can potentiate nitroglycerin-related vasodilation and headache. In people using nitrates for angina, this may increase the chance of symptomatic hypotension, dizziness, severe headache, or fainting.
Mechanism. NAC supplies sulfhydryl groups and can augment nitrate biotransformation and nitric-oxide-mediated vasodilation. Human studies show NAC enhanced nitroglycerin-induced headache and vascular responses.
Recommendation. Do not add NAC to nitroglycerin therapy without prescriber approval. If your clinician intentionally uses both, monitor blood pressure and report severe headache, dizziness, fainting, or worsening chest pain promptly.
Sources (2)
- Iversen HK. N-acetylcysteine enhances nitroglycerin-induced headache and cranial arterial responses. Clinical Pharmacology and Therapeutics. 1992;52(2):125-133. PMID 1505148
- Horowitz JD, Henry CA, Syrjanen ML, et al. Combined use of nitroglycerin and N-acetylcysteine in the management of unstable angina pectoris. Circulation. 1988;77(4):787-794. PMID 3127076
Stack Score
How this pair moves the number.
Effect on the composite score
If both NAC and Nitroglycerin are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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