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Licorice and Nitrolingual

Determining the interaction of Licorice and Nitrolingual and the possibility of their joint administration.

Check result:

Licorice <> Nitrolingual

Relevance: 04.06.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Talk to your doctor before using licorice together with nitroglycerin. Products containing licorice (glycyrrhizic acid) can cause high blood pressure as well as salt and water retention, which may interfere with the effects of nitroglycerin. Generally, you should avoid or limit the consumption of licorice if you have high blood pressure, heart failure, pulmonary hypertension (high blood pressure in the vessels of the lung), or kidney disease. Check your food and medicine labels to be sure those products do not contain licorice or glycyrrhizic acid, which may be found in licorice-flavored chewing gum or candy, chewing tobacco, certain ethnic foods and beverages, and some herbal diuretics or laxatives. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Licorice use has been associated with hypertension and may antagonize the effects of antihypertensive agents. Glycyrrhizic acid, a component of licorice, is hydrolyzed in the intestine to a metabolite (glycyrrhetinic acid) that causes mineralocorticoid and renin-suppressing effects. In one study, licorice was found to increase blood pressure in a dose-dependent manner. Healthy volunteers who consumed licorice 50 to 200 g/day (corresponding to 75 to 540 mg/day of glycyrrhetinic acid) for two to four weeks had a 3.1 to 14.4 mmHg increase in their systolic blood pressure. Even the lowest dosage demonstrated a significant effect. In another study, plasma potassium levels decreased by 0.3 to 1.5 mEq/L in 12 out of 14 healthy volunteers who ingested licorice 100 or 200 g/day (equivalent to 700 to 1400 mg/day of glycyrrhizic acid) for one to four weeks, including four who had to be withdrawn from the study because of hypokalemia. Two more subjects were withdrawn due to edema of the face, hands, and ankles. Other side effects reported include mild, transient generalized edema; headache; sodium retention; and weight gain (1 to 4 kg, mean 1.5 kg). Signs of renin-angiotensin-aldosterone suppression were observed in all subjects, especially plasma renin activity and urinary aldosterone concentrations, which fell to subnormal or undetectable levels in the majority of subjects. There have been various published case reports of refractory hypertension, severe hypokalemia (life-threatening hypokalemic paralysis, myopathy, arrhythmia, or cardiac arrest), and hypertensive encephalopathy in association with licorice intoxication. Hypertension and hypokalemia have also been reported with moderate doses of licorice in the form of licorice-flavored chewing gum or candy, chewing tobacco, or licorice-based foods and beverages consumed on a chronic basis. Prolonged use of licorice has led to a hypermineralocorticoid (pseudohyperaldosteronism) syndrome characterized by hypertension, hypernatremia, hypokalemia, metabolic alkalosis, renin-angiotensin-aldosterone suppression, and edema. In studies and case reports, licorice toxicity has generally been completely reversible within one to several weeks of licorice discontinuation. However, renin-angiotensin-aldosterone axis may be suppressed for up to several months.

MANAGEMENT: Patients receiving antihypertensive therapy should avoid or limit the consumption of licorice-containing products. Even relatively moderate doses of licorice may be problematic in susceptible patients when ingested regularly for prolonged periods.

References

Cumming A "Severe reduction of serum potassium induced by licorice." Nurs Times 72 (1976): 367-70
Stewart PM, Wallace AM, Valentino R, Burt D, Shackleton CH, Edwards CR "Mineralocorticoid activity of liquorice: 11-beta-hydroxysteroid dehydrogenase deficiency comes of age." Lancet 2 (1987): 821-4
Cumming AM "Metabolic effects of licorice." Br Med J 1 (1977): 906
Elinav E, Chajek-Shaul T "Licorice consumption causing severe hypokalemic paralysis." Mayo Clin Proc 78 (2003): 767-8
Holmes AM, Young J, Marrott PK, Prentice E "Pseudohyperaldosteronism induced by habitual ingestion of liquorice." Postgrad Med J 46 (1970): 625-9
Clyburn EB, DiPette DJ "Hypertension induced by drugs and other substances." Semin Nephrol 15 (1995): 72-86
Epstein MT, Espiner EA, Donald RA, Hughes H "Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects." Br Med J 1 (1977): 488-90
Farese RV, Biglieri EG, Shackleton CH, Irony I, Gomez-Fontes R "Licorice-induced hypermineralocorticoidism." N Engl J Med 325 (1991): 1223-7
Dellow EL, Unwin RJ, Honour JW "Pontefract cakes can be bad for you: refractory hypertension and liquorice excess." Nephrol Dial Transplant 14 (1999): 218-20
de Klerk GJ, Nieuwenhuis MG, Beutler JJ "Lesson of the week: hypokalaemia and hypertension associated with use of liquorice flavoured chewing gum." BMJ 314 (1997): 731
Cumming AM, Boddy K, Brown JJ, et al "Severe hypokalaemia with paralysis induced by small doses of liquorice." Postgrad Med J 56 (1980): 526-9
Epstein MT, Espiner EA, Donald RA, Hughes H "Liquorice toxicity and the renin-angiotensin-aldosterone axis in man." Br Med J 1 (1977): 209-10
Sigurjonsdottir HA, Franzson L, Manhem K, Ragnarsson J, Sigurdsson G, Wallerstedt S "Liquorice-induced rise in blood pressure: a linear dose-response relationship." J Hum Hypertens 15 (2001): 549-52
Edwards CR "Lessons from licorice." N Engl J Med 325 (1991): 1242-3
Ishikawa S, Kato M, Tokuda T, Momoi H, Sekijima Y, Higuchi M, Yanagisawa N "Licorice-induced hypokalemic myopathy and hypokalemic renal tubular damage in anorexia nervosa." Int J Eating Disorder 26 (1999): 111-4
Rosseel M, Schoors D "Chewing gum and hypokalaemia." Lancet 341 (1993): 175
Bannister B, Ginsburg R, Shneerson J "Cardiac arrest due to liquorice-induced hypokalaemia." Br Med J 2 (1977): 738-9
Richard CL, Jurgens TM "Effects of natural health products on blood pressure." Ann Pharmacother 39 (2005): 712-20
Lin SH, Yang SS, Chau T, Halperin ML "An unusual cause of hypokalemic paralysis: chronic licorice ingestion." Am J Med Sci 325 (2003): 153-6
Nielsen I, Pedersen RS "Life-threatening hypokalaemia caused by liquorice ingestion." Lancet 1 (1984): 1305

Licorice

Generic Name: licorice

Brand name:

Synonyms: n.a.

What is Licorice?

Nitrolingual

Generic Name: nitroglycerin

Brand name: Gonitro, Nitrolingual, NitroMist, Nitrostat, Nitro-Time, Gonitro, Minitran, Nitro TD Patch-A, Nitro-Dur, Nitro-Bid, Nitrol Appli-Kit, Rectiv

Synonyms: n.a.

What is Nitrolingual?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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