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, an 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.12
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 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 (To view, roll mouse over the "References" heading; to hide, click on the heading)
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.
The information presented in Aisle7 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 February 2010.
