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.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 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
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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2006-09-07
