Drug General Information (ID: DDI3UDOZYQ)
Drug Name			Nesiritide		Drug Info		Nitrous acid		Drug Info
Drug Type		Hormones				Small molecule
Therapeutic Class		Recombinant Natriuretic Peptide				Antidotes
Structure

Mechanism of Nesiritide-Nitrous acid Interaction (Severity Level: Moderate)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Nesiritide				Nitrous acid
Mechanism		Hypotensive effects Guanylate cyclase  Agonist				Hypotensive effects Guanylate cyclase  Agonist
Key Mechanism Factor 1
		Factor Name		Guanylate cyclase soluble				Structure Sequence
		Protein Family		Adenylyl cyclase class-4/guanylyl cyclase family
		Protein Function		There are two types of guanylate cyclases: soluble forms and membrane-associated receptor forms. Activated by nitric oxide in the presence of magnesium or manganese ions.     Click to Show/Hide
Mechanism Description		Additive hypotensive effects by the combination of Nesiritide and Nitrous acid

Recommended Action
Management		Sodium nitrite should be used with caution in the presence of concomitant antihypertensive agents, diuretics, vasodilators, or PDE5 inhibitors. Hemodynamics should be monitored during and after administration of sodium nitrite, and the infusion rate decreased if significant hypotension occurs. In addition, methemoglobin levels should be monitored and oxygen administered during treatment whenever possible.

References
1	Fuhr U, Maier-Bruggemann A, Blume H, et al. "Grapefruit juice increases oral nimodipine bioavailability." Int J Clin Pharmacol Ther 36 (1998): 126-32. [PMID: 9562227]
2	Gunston GD, Mehta U "Potentially serious drug interactions with grapefruit juice." S Afr Med J 90 (2000): 41. [PMID: 10721388]
3	Product Information. Sodium Nitrite (sodium nitrite). Hope Pharmaceuticals, Scottsdale, AZ.