Trinity, Texas - Isosorbide Dinitrate; Isosorbide dinitrate (ISDN) is used primarily to prevent ...

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Also indexed as:

Isordil, Sorbitrate

Isosorbide dinitrate (ISDN) is used primarily to prevent and treat angina, and in the treatment of acute heart attacks and heart failure.

Herbs

Summary of Interactions for Isosorbide Dinitrate

Depletion or interference	None known
Adverse interaction	Alcohol
Side effect reduction/prevention	None known
Supportive interaction	High fat meals N-acetyl cysteine
Reduced drug absorption/bioavailability	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

N-acetyl cysteine

The beneficial effects of ISDN are reduced following long-term treatment with the drug through a process known as tolerance. Controlled studies have shown that using intravenous and oral N-acetyl cysteine (NAC) reverses or prevents tolerance to nitrates.^1,² Another controlled study revealed that intravenous NAC enhanced the beneficial effects of ISDN on heart function.³ Therefore, people taking isosorbide dinitrate might benefit from supplemental NAC.

Other Interactions

Food

Taking sustained-release tablets of ISDN with a high-fat meal might increase the absorption of the drug.⁴ Individuals who switch from a high-fat diet to a low-fat diet might require a change in the amount of ISDN taken daily. Therefore, people taking ISDN should talk with their healthcare practitioner before starting a low-fat diet.

Alcohol

People taking ISDN might experience lightheadedness on standing, especially after rising from a lying-down or seated position. Drinking alcohol with ISDN may increase the frequency of this side effect.⁵ Therefore, individuals taking ISDN should avoid drinking alcohol.

References

Boesgaard S, Aldershvile J, Poulsen HE. Preventive administration of intravenous N-acetylcysteine and development of tolerance to isosorbide dinitrate in patients with angina pectoris. Circulation 1992;85:143-9.
Vincent J, Kongpatanakul S, Blaschke TF, Hoffman BB. Desensitization of nitrate-induced venodilation: reversal with oral N-acetylcysteine in humans. J Cardiovasc Pharmacol 1992;20:907-12.
Mehra A, Shotan A, Ostrzega E, et al. Potentiation of isosorbide dinitrate effects with N-acetylcysteine in patients with chronic heart failure. Circulation 1994;89:2595-600.
Sata H, Inoue K, Nii T, Juroda T. Influence of diet on the single-dose pharmacokinetics of isosorbide 5-mononitrate and sustained-release isosorbide dinitrate. Biol Pharm Bull 1997;20:1111-5.
Sifton DW, ed. Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 566-8.

Last Review: 09-01-2007

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2008.