.
Isosorbide dinitrate (ISDN) is used primarily to prevent and treat angina, and in the treatment of acute heart attacks and heart failure.
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.
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 |
For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
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 VitaminLore 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.