Nitrate tolerance

Overview

N-Acetyl Cysteine (NAC) is the only supplement listed for nitrate tolerance, with low-strength evidence across five studies. Intravenous NAC appears to help prevent tolerance to medicines such as nitroglycerin, while oral NAC results have been mixed.

The route of administration may matter, but overall evidence remains limited with low effect size and trust ratings. It is unclear whether oral NAC offers consistent benefit.

See the heatmap and evidence reviews below.

Effect graph

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Relevant supplements

Relevant supplements sorted by DEX Score.


N-Acetyl Cysteine (NAC)	★★★★★	Low

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Studies

Find individual evidence reviews for supplements sorted by DEX Score.

1 supplement for rated at least stars. All purchase bands. No minimum star filter.

N-Acetyl Cysteine (NAC)View supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceHighTrustMedium

Hospital IV/IM therapy — not an oral supplement

Evidence Review

Intravenous N-acetylcysteine (NAC) seems to help prevent tolerance to medicines like nitroglycerin.
Taking NAC by mouth has shown mixed results.

Browse 5 studies

RCTEffect of transdermal nitroglycerin or N-acetylcysteine, or both, in the long-term treatment of unstable angina pectoris1997n=200

A 4-month RCT of 200 angina patients found transdermal nitroglycerin plus NAC improved exercise tolerance and reduced nitrate tolerance versus nitroglycerin alone.

Effect: Benefit
Duration: 4 months
Population: Unstable angina patients
Participants: 200

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Clinical trialDifferent susceptibility to the development of nitroglycerin tolerance in the arterial and venous circulation in humans. Effects of N-acetylcysteine administration1992n=20

A study of 20 angina patients found arterial and venous beds differed in susceptibility to nitroglycerin tolerance during combined NAC therapy.

Population: ALL patients
Participants: 20

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RCTPreventive administration of intravenous N-acetylcysteine and development of tolerance to isosorbide dinitrate in patients with angina pectoris1992n=10

An RCT of 10 patients found preventive IV NAC (5 mg/kg) delayed development of nitrate tolerance during continuous nitroglycerin infusion.

Effect: Benefit
Duration: 30 hours
Dose: 5 mg/kg
Population: Angina patients
Participants: 10

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RCTChronic administration of N-acetylcysteine fails to prevent nitrate tolerance in patients with stable angina pectoris1990

An RCT found chronic NAC (10 mg/day) failed to prevent nitrate tolerance during long-term nitroglycerin therapy.

Effect: No Benefit
Duration: 4 days
Dose: 10 mg/day
Population: Stable angina patients

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RCTN-acetylcysteine fails to attenuate haemodynamic tolerance to glyceryl trinitrate in healthy volunteers1989

An RCT found NAC (200 mg three times daily) did not attenuate hemodynamic tolerance to glyceryl trinitrate in angina patients.

Effect: No Benefit
Duration: 4 days
Dose: 200 mg 3×/day
Population: Healthy adults

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Evidence visualised

Same ratings as above, aggregated so you can see coverage and imbalance.

Purchase-guidance distribution

How many supplements fall in each purchase band

Effect-size distribution

How large the reported benefits tend to be

Study distribution across 1 supplements for nitrate tolerance (5 studies total).
Supplement	DEX	Studies	Meta-analyses	Share
N-Acetyl Cysteine (NAC)	★★★★★52%	5	0	100%

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Overview

Effect graph

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Studies

Evidence visualised

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