Isosorbide Dinitrate

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Also indexed as: Angitak, Cedocard Retard, Isocard, Isoket Retard, Isordil, Sorbid SA, Sorbitrate

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

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

May Be Beneficial: Supportive interaction—Taking these supplements may support or otherwise help your medication work better.	High fat meals N-acetyl cysteine
Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.	Alcohol
Depletion or interference	None known
Side effect reduction/prevention	None known
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 Dietary 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.

Interactions with Foods and Other Compounds

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 doctor 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

1. 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.

2. 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.

3. 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.

4. 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.

5. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 566–8.

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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 chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires August 2007.