N-Acetyl Cysteine (NAC)

Possible Benefits and Risks

N-acetyl cysteine (NAC) is a specially modified form of the dietary amino acid cysteine that has various proposed uses.

Nitrates such as nitroglycerin lose some of their effectiveness over time. According to some studies, 1,2 but not all, 3,4 the supplement N-acetyl cysteine might help these drugs work better. However, there's a catch: the combination of NAC and nitroglycerin appears to cause severe headaches. 5,6

Taking NAC with nitroglycerin may be beneficial in some cases. However, unpleasant side effects probably limit the use of this combination.

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.

Vitamin C

Supplementation Possibly Helpful

Vitamin C may help prevent the development of tolerance to nitrate medications such as nitroglycerin. According to a double-blind study of 48 individuals, use of vitamin C at a dose of 2000 mg three times daily helped maintain the effectiveness of nitroglycerin. 10 These findings are supported by other studies as well. 9,13,14

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.

Arginine

Supplementation Possibly Helpful

According to a small, double-blind, placebo-controlled crossover study, use of arginine (700 mg four times daily) may help prevent tolerance to nitrate medications. 15

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on physician’s advice.

Folate

Supplementation Possibly Helpful

A small, double-blind trial suggests that folate supplements (at the high dose of 10 mg daily) may help prevent tolerance to nitrate medications. 11

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.

Vitamin E

Supplementation Possibly Helpful

A small, double-blind trial suggests that vitamin E at a dose of 200 mg three times daily may help prevent tolerance to nitrate medications. 12

Note: Angina is too serious a disease for self-treatment. If you have angina, do not take any supplement except on a physician’s advice.