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bulletNatural Progesterone
bulletWhat Is Progesterone?
bullet The Feel Good Superhormone
bullet Proof Positive: Natural Progesterone, Is Better
bullet Progesterone Is a Bone Builder
bullet Progesterone Alone?
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Excerpts from "The Super-Hormone Promise" by William Regelson, M.D. & Carol Colman

THE FEEL GOOD HORMONE FOR WOMEN 

bulletProtects against cancer 
bulletNatural tranquilizer
bulletPromotes feelings of well being
bulletEnhances action of estrogen
bulletRelieves menopausal symptoms
bulletMay stimulate new bone formation
bulletPotential treatment for nerve disease



Estrogen is a, superhormone, that reverses many of the ravages of aging and prevents and treats many of the conditions that can age women prematurely.


But estrogen is only part of the story!


There is another female hormone of equal importance to women, although it is rarely discussed. It is a superhormone that has been given short shrift by physicians, the research community, pharmaceutical companies, and the FDA, to the great detriment of women. It is a superhormone that in many cases can safely and effectively relieve menopausal symptoms, protect against cancer, and prevent osteoporosis.. Yet, because it is so ignored, few women are taking it.
The superhormone is natural progesterone, with the emphasis on the word "natural." Today, most women take synthetic versions of progesterone, or progestins, with estrogen. Yet, as you will see, this is not what Mother Nature had in mind.

Natural progesterone enhances the action of estrogen, and according to Mother Nature's blueprint, these two superhormones were meant to work together. When women are in their youthful prime, and estrogen and progesterone are at their adult peaks, these superhormones work together to maintain the normal hormonal balance within their bodies.  At midlife the levels of both these superhormones decline, leaving women vulnerable to diseases such as osteoporosis and heart disease, and to other changes in their bodies that can severely diminish their quality of life. The combination of natural progesterone and estrogen can prevent this downward spiral by keeping women vital, strong, and sexy, and that is why they are both superhormones.

In addition to enhancing the action of estrogen, natural progesterone is a potent anti aging superhormone in its own right; it can do some things that estrogen cannot.

Before I tell you about the wonders of natural progesterone, let me first explain the difference between natural and synthetic products.  When used in the context of superhormones, the word "natural" is actually a misnomer, since all the superhormone supplements are synthetic products that undergo some degree of chemical processing. Here, "natural" refers to the chemical structure of the superhormone. A natural hormone simply means one that is identical in structure to the hormone naturally produced by the body. By comparison, a "synthetic" hormone is one that has the same action as the hormone produced by the body but has a slightly different chemical structure.

The form of progesterone most commonly now used in the United States is the synthetic form, which is called progestin. The most commonly prescribed brand of progestin is Provera, or medroxyprogesterone. Progestin was developed in the 1930s from diosgenin, a compound found in wild yams, and was used as an ingredient in birth control pills. At one time progestin was considered superior to natural progesterone because the form of natural progesterone then available was not as readily absorbed by the body. This is no longer the case. Today's natural progesterone undergoes a process called micronization, which breaks it up into tiny particles that are easily absorbed, and micronized progesterone is now used in all oral preparations.

I am among a growing number of physicians who do not believe that synthetic progestins work as well for women as natural progesterone. Nor do I believe that they offer the same health benefits. There is another important reason that I prefer natural progesterone. I call natural progesterone the "feel good" superhormone because most women feel better on natural progesterone than they do on synthetic progestins, for reasons that I will explain shortly. (Before continuing, I want to stress that there is nothing wrong with using progestin. My only objection to it is that I feel natural progesterone is a better choice. If a woman is taking progestin with estrogen and feels fine on it, however, there is no need for her to switch. If a woman does not feel well on progestin, however, or is just starting on estrogen, then I think that she and her physician should strongly consider using natural progesterone.)

Despite the growing evidence that natural progesterone is better for women, it has been extremely difficult to get the medical community to focus on it. The reason that natural progesterone has been overlooked is precisely the same reason that superhormones like DHEA, pregnenolone, and melatonin were, until recently, pretty much ignored. Natural progesterone is a natural substance that cannot be patented. Consequently, pharmaceutical companies have no, financial incentive to study and market it. As I have said repeatedly, one of my goals in writing The Superhormone Promise is to "rescue" natural progesterone and other superhormones from neglect and to make sure they receive the attention and funding for the research they deserve.

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What Is Progesterone?

"Pro" and "gesterone" mean "for gestation." As its name might suggest, progesterone is produced in huge amounts by the placenta during pregnancy. If a woman does not produce enough progesterone, she will have difficulty carrying her pregnancy to term, and this is why progesterone is often prescribed during pregnancy to women with a history of miscarriage. In fact, the so called abortion pill used in France, RU 486, works by blocking the action of progesterone. This results in a spontaneous abortion of the pregnancy.
As most women know, hormones can have a profound effect on mood, and progesterone is no exception; it is a natural antidepressant. Progesterone is the hormone that gives pregnant women a sense of well being and contentment. It is also a natural tranquilizer and, in high enough doses, can even be used as an anesthetic.

Progesterone plays a major role in the menstrual cycle, which could not occur without it. The menstrual cycle prepares a woman's body for pregnancy. The cycle involves a delicate interplay of several hormones, the most important of which are estrogen and progesterone. Estrogen levels rise during the first half of the menstrual cycle when the egg forming cells in the ovaries, called follicles, are prepared for ovulation, which occurs around mid cycle. During ovulation the follicle ruptures, and the mature egg cell travels down the fallopian tubes to the uterus or womb, where it can unite with sperm and become fertilized. The remaining portion of the follicle becomes the corpus luteum, a glandlike structure that produces progesterone. During the second half of the menstrual cycle, a woman's levels of progesterone rise steadily, stimulating the growth of the uterine lining in order to prepare it to receive the fertilized egg. If the egg is not fertilized, the levels of progesterone drop off, triggering the sloughing off of cells on the uterine wall. It is the decline in progesterone that triggers a woman's monthly bleeding.

Almost every woman (and by now most men) know about the condition called premenstrual syndrome, or PMS. PMS.is characterized by a combination of symptoms, including moodiness, irritability, bloating, and headaches that occur seven to ten days before the onset of menstruation. PMS occurs during the time of the cycle when progesterone levels are supposed to be high, but many women who suffer from PMS have lower than normal progesterone levels. That is why one common treatment for PMS is to take progesterone supplements during the second half of the menstrual cycle to boost levels, to normal. Although progesterone does not cure all cases of PMS, it has been used successfully to treat many.

Progesterone is produced primarily at three sites in the body: the corpus luteum (the ruptured follicle), the adrenal glands, and, in pregnant women, the placenta.

By the time a woman reaches her thirties, her progesterone levels begin to decline. Not only do her progesterone producing adrenal glands begin to slow down, but she may also begin to have erratic menstrual periods, which will also affect her progesterone levels. It is not uncommon, in fact, for a woman in her thirties or forties to experience what are known as anovulatory cycles. During an anovulatory cycle, estrogen may stimulate the buildup of the uterine lining, but ovulation does not occur. As a result, there is no ruptured follicle :to produce a corpus luteum, and no corpus luteum to produce progesterone. When estrogen levels fall, the uterine lining is shed, as in a normal period, but it is not a normal period. Anovulatory periods can become more frequent as menopause approaches. This means :that there is no monthly surge in progesterone levels. After menopause, when ovulation stops completely, progesterone production is virtually nil.

The question is, since progesterone levels decline, do women need to boost their progesterone back to youthful levels? For years the medical community said no. The prevailing wisdom was that since menopause is an estrogen deficient state, estrogen is the only hormone that should be replaced. And, when estrogen replacement therapy was pioneered in the 1960s, estrogen was routinely given alone or, in scientific terms, unopposed to millions of women. The problem with this practice was that it completely ignored what nature so clearly intended: that estrogen and progesterone should work in tandem. Unfortunately, the effect of ignoring nature's blueprint was disastrous. In the mid 1970s researchers discovered that women taking unopposed estrogen had an alarmingly high rate of uterine cancer, up to fourteen times the normal rate for women their age.
Also very disturbing was the fact that up to a third of women who,
used estrogen were developing hyperplasia, a condition of the uterine 
lining that could presage cancer. Estrogen quickly fell into disfavor,
and physicians and women steered clear of it. This was no solution,
however, for the millions of women who were suffering from menopausal symptoms, who were losing significant amounts of bone, and
who were becoming more likely .candidates for heart disease.
Finally, researchers took a look at nature's blueprint and saw that
there was a simple answer to the estrogen problem: If they gave
progesterone along with estrogen, the progesterone would perform
the same function that it had in the menstrual cycle. In other words,
the progesterone would prevent the buildup of excess uterine tissue
and, by doing so, protect against cancer. 

Several major studies have since confirmed that progesterone in
combination with estrogen does indeed provide remarkable protection against uterine cancer. As a result, women are no longer advised
to use estrogen alone unless they have undergone hysterectomies (the
surgical removal of the uterus). Today, most women who use estrogen take a small amount of a synthetic progesterone, called progestin,
every day along with estrogen, or they take progestin for about
twelve days each month following estrogen to prevent buildup of
uterine .tissue. If the progestin is used for only part of the month, it
will trigger some bleeding, albeit usually lighter than a normal menstrual period.
The interdependency of progesterone and estrogen is a great illustration of the principle on which the superhormone promise is founded. That principle is not to boost any single superhormone to an artificially high level but rather to restore the youthful balance between key hormones. Nature provided us with a wonderful model and blueprint, and all we need to do is follow it as faithfully as
we can.


You may have noticed that medical researchers decided to add progesterone to estrogen pretty much as an afterthought and solely because it moderated the effect of estrogen, and not because of any positive properties it might have. In the years since women started using progesterone, however, we have learned that, like estrogen, progesterone is a superhormone that has wonderful properties of its own.

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The Feel Good Superhormone

As explained earlier, natural hormones are, identical in chemical structure to the hormones that our bodies produce naturally, and therefore they are less likely than synthetic hormones to cause side effects. Women who take synthetic progesterone sometimes complain of bloating, headaches, moodiness, or other side effects not usually experienced by women taking natural progesterone. Moreover, instead of causing irritability and mood swings, natural progesterone does just the opposite: It has a mild tranquilizing effect and enhances feelings of well being. Indeed, most women using it, report that they actually feel better during the time of month when they are taking natural progesterone. As one former synthetic progestin user put it, "When I was taking synthetic progestin, I felt as if I was between a rock and a hard place. I was ready to quit hormones altogether because I hated the progestin days. I felt tired, moody, and real jumpy. Since I have low bone density, however, I was afraid of getting osteoporosis, so I was reluctant to stop taking hormones. A friend recommended that I try using natural progesterone, but when I asked my doctor about it, she had never heard of it. She did a bit of research and then decided that it was okay to prescribe it. It was the difference between day and night. I don't get headaches, and I don't feel dragged out on the progesterone, days as I did on progestin."

Although it is not marketed with the same vigor as synthetic progestin, oral forms of micronized natural progesterone in varying strengths are sold by prescription by compounding pharmacies such as the Women's International Pharmacy, the Medical Center Pharmacy, the Bajamar Pharmacy, Stark Pharmacy, and others. Natural progesterone is also available by prescription in vaginal suppositories and skin creams. Progesterone creams in weaker strengths are sold over the counter in pharmacies and health food stores.


Few studies have compared women's reactions to progestin and natural progesterone, but one such study yielded results that should be of interest to every woman taking superhormones. Dr. Joel T. Hargrove and a group of researchers at Vanderbilt University Medical Center compared ten menopausal women using natural estrogen and natural oral progesterone with five women taking synthetic estrogen, Premarin, and synthetic progestin. The study showed that the women who used natural estrogen and natural progesterone daily fared the best. Their menopausal symptoms improved dramatically, and they had the fewest side effects. In addition, the natural progesterone offered the same protection against uterine cancer as did the 
progestin.
They also discovered some unexpected benefits, related to the use of natural progesterone: The women on the natural hormones had a greater reduction in cholesterol levels and an increase in levels of HDL, the good cholesterol. Perhaps what is most telling of all is that at the end of the study, all of the ten women who were using the natural superhormones wanted to continue with them, whereas two of the five women taking the synthetic hormones wanted to quit.

The Vanderbilt study not only highlights the positive effects of natural progesterone but shows that no matter how beneficial a treatment may be, if it makes us feel bad, we will not stay with it.

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Proof Positive: Natural Progesterone, Is Better

There is other compelling evidence that natural progesterone is superior to progestin. When progesterone was first added to estrogen, researchers were concerned that it might interfere with estrogen's positive effects on cholesterol. We know that after menopause a woman's risk of developing heart disease rises dramatically and that 250,000 women die of heart disease each year. As we saw in the previous chapter, the belief is that there is a direct connection between falling levels of estrogen and the rising rate of heart disease. As we also saw, women who take estrogen cut their risk of dying from heart disease in half, in part because estrogen reduces levels of LDL, the bad cholesterol, and raises levels of HDL, the "good" cholesterol. Scientists feared that if women were given progesterone along with estrogen, it would negate estrogen's beneficial effect on cholesterol.
In January 1995 an article in the Journal of the American Medical Association reported some surprising results from the first major clinical trial to examine the effect of sex hormones on heart disease risk factors in postmenopausal women. The study to which the article referred was called "The Postmenopausal Estrogen/Progestin Interventions," or the "PEPI trials" for short. In the PEPI trials, researchers tracked 875 women aged forty five to sixty four for three years. The women were randomly assigned to one of five treatment groups, as described below:

1. One group was given a placebo.
2. One group was given daily estrogen (Premarin) alone.
3. One group was given estrogen (Premarin) daily and synthetic progestin for twelve days per month:
4. One group was given daily estrogen (Premarin) and synthetic progestin.
5. One group was given estrogen (Premarin) daily and natural oral progesterone for twelve days per month.

The PEPI trials found that estrogen. alone had the most beneficial effect in that it increased HDL more than any of the other regimes. However, one third of the women taking estrogen alone, or unopposed, developed uterine hyperplasia, which made this treatment unacceptable. That's the bad news. The good news is that there was a safe treatment that worked nearly as well as, estrogen alone. By now you may have guessed that it is estrogen combined with natural progesterone, which came in a close second in terms of raising HDL levels but without producing the precancerous changes in the uterus. Although synthetic progestin combined with estrogen worked better than the placebo in terms of reducing risk factors for heart disease and protecting the uterus, it could not compete with the natural progesterone/estrogen combination.
To sum up, the PEPI trials clearly demonstrated that

• natural progesterone actually works better than progestin in terms of protecting the heart
• natural progesterone can protect against uterine cancer as, well as synthetic progestin


Other studies have confirmed that women feel better on natural progesterone. Yet, inexplicably, this message has not yet reached the medical community. The overwhelming majority of doctors still write prescriptions for progestin, and most do not even know that there is a different, and in my view better, kind of progesterone available.
The situation appears to be changing, however. There is a grassroots movement of knowledgeable women who have themselves undertaken to research the best superhormone strategies for menopause and who are now demanding that their physicians prescribe natural progesterone. The FDA has not yet approved natural progesterone for use during menopause, and because of this, some doctors are reluctant to prescribe it. And because no drug company stands to profit from marketing it, no one is undertaking. the expensive kinds of studies the FDA needs before it approves a new drug.
Because natural progesterone cream is sold over the counter, some women have taken matters into their own hands: They use it along with estrogen instead of taking an oral progestin or natural progesterone. There is nothing wrong with using a progesterone cream, but the kind that is sold over the counter may not be strong enough to counteract the effect of estrogen on the uterus for some women. If you are using an over the counter progesterone cream along with estrogen, be sure that you are being monitored by your physician so that your physician can watch for signs of uterine hyperplasia. In some cases your physician may decide to take an endometrial biopsy, a sample of the endometrial tissue, to make sure that it is normal. When all is said and done, though, I think you are, better off finding a doctor who will write a prescription for natural, progesterone and make sure you are getting the proper dosage. Whatever superhormone strategy you choose, it is always best to work together with your physician. (

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Progesterone Is a Bone Builder

Up to this point I have been discussing natural progesterone as an adjunct to estrogen, but, as suggested earlier, it has some wonderful properties of its own. One is its role as a bone builder.

One of the primary reasons that doctors prescribe estrogen is to halt the progression of osteoporosis, the thinning or wearing down of bones that leaves them vulnerable to fracture. Let me briefly summarize the cause of osteoporosis and the role that hormones play in this process. Throughout our lives, our bones undergo a continuous process called remodeling in which old bone is broken down and new bone is created in its place. The cells that destroy old bone are called osteoclasts, and the cells that make new bone are called osteoblasts. As long as new bone is made at least as quickly as old bone is destroyed, our skeletons remain strong. After age thirty five, however, the osteoclasts (bone breakers) outpace the osteoblasts (bone builders), and men and women begin to lose about 1 percent of their bone mass annually. After menopause, the destructive process speeds up, and the average woman loses from 2 to 4 percent of her bone mass each year for about the next decade. After that, the bone loss begins to level off, but much of the damage has already been done. By the time a woman is in her sixties or seventies, her bones may be so thin and brittle that even a minor fall can result in a major fracture, and major fractures often result in death from complications.
As we saw in the previous chapter on estrogen, the rapid loss of bone after menopause has been attributed to the decline in the production of estrogen, which is essential for the maintenance of calcium, a mineral necessary for bone growth. Although we do not fully understand the precise role estrogen plays in bone formation, we do know that there are estrogen receptors in bone and that estrogen affects the activity of the osteoclasts. Although estrogen can very effectively stop bone loss, it cannot promote the growth of new bone. Nor is it a cure for osteoporosis. Studies have shown that estrogen can prevent up to 50 percent of all fractures; but the flip side of that equation is the sobering fact that estrogen still does not prevent half of all fractures. Women who take estrogen are still at risk of breaking a bone, although they are at a greatly reduced risk.

Recent studies demonstrate that progesterone can halt the loss of bone at least as well as estrogen. Dr. Jerilynn C. Prior, of the University of British Columbia in Vancouver, has performed some groundbreaking studies on the role of progesterone in the maintenance of bone, and her work in both animals and humans has clearly demonstrated that it can arrest bone loss. But what is even more exciting is that Dr. Prior has shown progesterone can do something that estrogen can't: It can stimulate osteoblasts to form new bone. For example, in animal studies, progesterone administered with or, without estrogen has been shown to not only stop bone loss but enhance new bone formation. In fact, some of these animal studies have shown that there are progesterone receptors, or binding sites, on osteoblasts, the cells that build bone.

Dr. John R. Lee, a California physician, is a well known proponent of natural progesterone. For three years Dr. Lee followed the progress of one hundred postmenopausal women, aged thirty eight to eighty three, who were at risk of developing osteoporosis. In addition to putting the women on a healthy diet, which included supplemental calcium and vitamin D, Dr. Lee prescribed estrogen (Premarin) to women who could take it, along with a natural progesterone cream that was applied daily during the last two weeks of estrogen use each month. For women who could not take estrogen he prescribed a natural progesterone cream applied twelve days a month. The women were instructed to get regular exercise, forbidden to smoke, and told to limit their alcohol intake.. At the end of three years, bone density studies of sixty three of the patients revealed that the regimen had not only slowed down the osteoporosis but had reversed it. These women had an increase in, bone density, which indicated that the patients had stopped losing bone and were actually gaining new bone. Dr. Lee notes that although some patients improved more than others, all the patients improved. Surprisingly, according to Dr. Lee, the patients taking the estrogen/progesterone combination did not fare any better than the patients taking proges terone alone. Dr. Lee, who has written several excellent books on natural progesterone, has come to the conclusion that osteoporosis is actually a disease of progesterone deficiency and that estrogen plays a minor role in osteoporosis if any. In support of his thesis; .Dr. Lee points out that even when a woman's estrogen levels are relatively high, when she is in her thirties and forties, she is beginning to lose bone. As mentioned earlier, by the time a woman reaches her thirties, her progesterone levels (but not her estrogen levels) have begun to decline, and this is consistent with Dr. Lee's analysis. Dr. Lee's work is provocative, and his thesis certainly warrants further investigation. In fact, let me not mince words: Given the fact that 25 percent of all women are at risk of developing osteoporosis, I think it is unconscionable that progesterone's role in this disease has been neglected.

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Progesterone Alone?

Countless numbers of women are now using over the counter natural progesterone creams to treat common symptoms of menopause, most notably hot flashes. Many report that these creams work well for mild menopausal symptoms, and they are content to use it. I can understand their position. Progesterone cream is easy to use (you simply rub it into your skin), you don't need a prescription to get it,
and you can buy it at your neighborhood drugstore. (Editors Note:It is no longer sold over the counter) I am concerned, however, that these women are cheating themselves because they are not following nature's blueprint and are not getting some of the benefits that only estrogen together with progesterone can offer. We know that natural progesterone protects against uterine cancer, that it appears to arrest bone loss and may promote bone growth, and that it does not counteract estrogen's positive effects on the heart. What we don't know, however, is whether progesterone can do everything that estrogen does. Estrogen is, among other things, an antioxidant that can protect against damage inflicted by free radicals. Progesterone is not an antioxidant, and there is no. evidence that it will offer the same protection against heart disease that estrogen does. As we saw in the last chapter, estrogen also appears to have a  positive effect on memory and may even inhibit Alzheimer's disease. Although natural progesterone enhances mood, there is no evidence that it has any effect on memory and learning. Estrogen reduces the risk of urinary tract infections and can restore vaginal function. As far as we know, progesterone does not. 

For me the key to the superhormone promise, as I've said before, is to follow nature's blueprint and recreate the same balance and harmony of superhormones as we enjoyed in our youth. That means replenishing, in this context, both natural progesterone and estrogen so that a woman will be able to realize the full benefit of the superhormone promise. 

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On the Horizon: An Exciting New Use for Progesterone 

The more we learn about superhormones such as progesterone, the more we learn about their amazing potential. Progesterone is no exception. 

In this regard, some of the most exciting work on progesterone is being done in France by a group headed by Dr. Etienne Emile Bau lieu, who is also a pioneer in DHEA research. Recently, Dr. Baulieu's team at the University of Paris found evidence that progesterone may be an effective treatment for certain nerve diseases, including multiple sclerosis.

It has long been known that progesterone is produced in the central nervous system and that it plays a role in helping nerves communicate with each other. That is why progesterone, like other superhormones such as estrogen and testosterone, are related to neurotransmitters, that is, substances that carry messages from nerve to nerve and help run the vast communication network within the body The French researchers found that progesterone is produced in yet another site in the nervous system, in special cells called Schwann cells. These are found in the peripheral nervous system, the collection of nerves that branch off from the central nervous system. In the peripheral nervous system, progesterone may play a previously undetected role in the maintenance of nerves, i.e., touch and motor function.

The French researchers discovered that progesterone promotes the formation of the myelin sheath, the fatty substance that surrounds and protects nerve fibers. The myelin sheath is, to nerves what plastic, insulation is to electrical wires. They, learned about progesterone's role in myelin formation by injuring nerves in the legs of male mice and monitoring the mechanism in the body that repaired the injury. These researchers noted that concentrations of progesterone were, significantly higher near the damaged nerves than in the blood, suggesting that progesterone plays a role in the healing process. To test this theory, the researchers added supplemental progesterone near the damaged nerves and then noticed that there was a significant increase in the thickness of new myelin sheaths. When researchers administered a drug that blocked the action of progesterone, they noted that the thickness of the new myelin sheaths was decreased. Based on these experiments, it appears as though progesterone does indeed play a role in myelin production and in repairing nerve injuries. 

The reason researchers are so excited about progesterone's newly discovered role in myelin formation is that several serious diseases can occur when myelin production is impaired, leaving the nerve tissues exposed. In fact, in multiple sclerosis, a disease of the central nervous system, the loss of myelin results in a breakdown of the nerve signaling system throughout the body. Symptoms of multiple sclerosis include muscle weakness or paralysis, vision problems, and lack of coordination. To date there is no cure and there are few effective treatments for multiple sclerosis. What is so exiting about the discovery of progesterone's role in myelin formation is that it may one day lead to a treatment for this disease and similar myelin deficiency diseases.

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Nitroderm TTS, 
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Minitran 3M Pharmaceuticals 
Nitrek Bertek Pharameuticals, Inc. 
Nitro-Bid Hoechst Marion Roussel 
Nitrodisc G.D. Searle Company 
Nitro-Dur Key Pharmaceuticals, Inc. 
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Nitroglyn Kenwood Laboratories 
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GTN Spray Rhone-Poulenc Rorer Pharmaceuticals, Inc. 
Nitrol Ointment (Appli-Kit) Savage Laboratories 
Nitrong Rhone-Poulenc Rorer Pharmaceuticals, Inc. 
Nitro-Par Parmed Pharmaceuticals 
Nitrostat Parke-Davis 
Nitro-Time Time-Cap Laboratories 
Transderm-Nitro Novartis Pharmaceuticals Corporation 
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Monoket Tablets Schwarz Pharma, Inc. 
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PENTAERYTHRITOL TETRANITRATE 
SODIUM NITROPRUSSIDE 

Substances such as amyl nitrate (poppers), which are sometimes abused, should never be combined with Sildenafil Citrate , other Viagra clones or VIAGRA. 
It is however not contradicated with nitrates found in foods. 

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