Isosorbide mononitrate interactions

Isosorbide mononitrate (Imdur, Monoket), a nitrate has 62 documented interactions across the FDA labels and fact sheets we index: 9 major, 44 moderate, 9 minor, and 0 where a label reports no significant interaction. Each entry below quotes the sentence behind it. This drug page is a starting point, not a verdict for your situation.

Interactions from the label

Major interactions (9)

  • AnagrelideQT-prolonging drugMajor

    Do not use isosorbide mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. (Isosorbide mononitrate label, Contraindications)

  • AvanafilPDE5 inhibitorMajor

    Do not use isosorbide mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. (Isosorbide mononitrate label, Contraindications)

  • Cilostazolantiplatelet agentMajor

    Do not use isosorbide mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. (Isosorbide mononitrate label, Contraindications)

  • MilrinonePDE3 inhibitorMajor

    Do not use isosorbide mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. (Isosorbide mononitrate label, Contraindications)

  • NitroglycerinnitrateMajor

    Hypersensitivity to Nitroglycerin Lingual Spray or to other nitrates or nitrites or any excipient. (Nitroglycerin label, Contraindications)

  • RiociguatvasodilatorMajor

    Do not use isosorbide mononitrate in patients who are taking the soluble guanylate cyclase stimulator riociguat. (Isosorbide mononitrate label, Contraindications)

  • SildenafilPDE5 inhibitorMajor

    Do not use isosorbide mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. (Isosorbide mononitrate label, Contraindications)

  • TadalafilPDE5 inhibitorMajor

    Do not use isosorbide mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. (Isosorbide mononitrate label, Contraindications)

  • VardenafilPDE5 inhibitorMajor

    Do not use isosorbide mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. (Isosorbide mononitrate label, Contraindications)

Moderate interactions (44)

  • AdenosineantiarrhythmicModerate

    Hypotension Adenosine injection is a potent peripheral vasodilator and can induce significant hypotension. (Adenosine label, Warnings and precautions)

  • AlcoholAlcoholModerate

    Alcohol, in particular, has been found to exhibit additive effects of this variety. (Isosorbide mononitrate label, Drug interactions)

  • Alfuzosinalpha blockerModerate

    Postural hypotension/syncope: Care should be taken in patients with symptomatic hypotension or who have had a hypotensive response to other medications or are concomitantly treated with antihypertensive medication or nitrates ( 5.1 ) (Alfuzosin label, Warnings and precautions)

  • Alprostadilprostaglandin analogModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • Amlodipinedihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Amlodipine and atorvastatindihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Amlodipine and benazeprildihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Amlodipine and olmesartandihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Amlodipine and valsartandihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Articaine and epinephrinelocal anestheticModerate

    Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine, tetracaine Antineoplastic agents cyclophosphamide, flutamide, hydroxyurea, ifosfamide, rasburicase Antibiotics… (Articaine and epinephrine label, Drug interactions)

  • Bupivacainelocal anestheticModerate

    • Drugs Associated with Methemoglobinemia : Patients are at increased risk of developing methemoglobinemia when concurrently exposed to nitrates, nitrites, local anesthetics, antineoplastic agents, antibiotics, antimalarials, anticonvulsants, and other drugs. (Bupivacaine label, Drug interactions)

  • Bupivacaine and epinephrinelocal anestheticModerate

    • Drugs Associated with Methemoglobinemia : Patients are at increased risk of developing methemoglobinemia when concurrently exposed to nitrates, nitrites, local anesthetics, antineoplastic agents, antibiotics, antimalarials, anticonvulsants, and other drugs. (Bupivacaine and epinephrine label, Drug interactions)

  • CaptoprilACE inhibitorModerate

    Valvular Stenosis There is concern, on theoretical grounds, that patients with aortic stenosis might be at particular risk of decreased coronary perfusion when treated with vasodilators because they do not develop as much afterload reduction as others. (Captopril label, Precautions)

  • Chloroprocainelocal anestheticModerate

    …methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics: Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine,… (Chloroprocaine label, Precautions)

  • Dexmedetomidinealpha-adrenergic agonistModerate

    • Co-administration with Other Vasodilators or Negative Chronotropic Agents : Use with caution due to additive pharmacodynamic effects. (Dexmedetomidine label, Warnings and precautions)

  • DicyclomineanticholinergicModerate

    …drugs including dicyclomine hydrochloride: amantadine, antiarrhythmic agents of Class I (e.g., quinidine), antihistamines, antipsychotic agents (e.g., phenothiazines), benzodiazepines, MAO inhibitors, narcotic analgesics (e.g., meperidine), nitrates and nitrites, sympathomimetic agents, tricyclic antidepressants, and other drugs having anticholinergic activity. (Dicyclomine label, Drug interactions)

  • Diltiazemcalcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • DofetilideantiarrhythmicModerate

    …oral anticoagulants, calcium channel blockers, beta blockers, cardiac glycosides, inducers of CYP3A4, substrates and inhibitors of CYP3A4, substrates and inhibitors of P-glycoprotein, nitrates, sulphonylureas, loop diuretics, potassium sparing diuretics, thiazide diuretics, substrates and inhibitors of tubular organic cation transport, and QTc-prolonging drugs. (Dofetilide label, Drug interactions)

  • Econazoleazole antifungalModerate

    Most cases reported product application with use under occlusion, genital application, or application to a large body surface area which may increase the systemic absorption of econazole nitrate. (Econazole label, Drug interactions)

  • Epoprostenolprostaglandin analogModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • Co-administration of vaginal miconazole nitrate and Etonogestrel/Ethinyl Estradiol Vaginal Ring increases the serum concentrations of etonogestrel and ethinyl estradiol by up to 40% [see Clinical Pharmacology (12.3) ] . (Etonogestrel and ethinyl estradiol label, Drug interactions)

  • Felodipinedihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • HydralazinevasodilatorModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • Isosorbide dinitratenitrateModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • Isradipinedihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Lidocaine and epinephrinelocal anestheticModerate

    Drugs Associated with Methemoglobinemia: Patients are at increased risk of developing methemoglobinemia when concurrently exposed to nitrates, nitrites, local anesthetics, antineoplastic agents, antibiotics, antimalarials, anticonvulsants, and other drugs. (Lidocaine and epinephrine label, Drug interactions)

  • Lidocaine and prilocainelocal anestheticModerate

    …methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics: Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine,… (Lidocaine and prilocaine label, Drug interactions)

  • Mepivacainelocal anestheticModerate

    …methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics: Examples of Drugs Associated with Methemoglobinemia: Class Examples Nitrates/Nitrites nitroglycerin, nitroprusside, nitric oxide, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine,… (Mepivacaine label, Drug interactions)

  • MinoxidilvasodilatorModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • NiacinModerate

    Caution should also be used when niacin extended-release tablets are used in patients with unstable angina or in the acute phase of an MI, particularly when such patients are also receiving vasoactive drugs such as nitrates, calcium channel blockers, or adrenergic blocking agents. (Niacin label, Warnings and precautions)

  • Nicardipinedihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Nifedipinedihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Nimodipinedihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Nisoldipinedihydropyridine calcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • NitroprussidevasodilatorModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • Olmesartan, amlodipine, and hydrochlorothiazideangiotensin II receptor blocker (ARB)Moderate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • PapaverinevasodilatorModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • Prilocaine and epinephrinelocal anestheticModerate

    …methemoglobinemia when concurrently exposed to the following drugs, which could include other local anesthetics: EXAMPLES OF DRUGS ASSOCIATED WITH METHEMOGLOBINEMIA: Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine,… (Prilocaine and epinephrine label, Drug interactions)

  • Ropivacainelocal anestheticModerate

    …exposed to the following drugs, which could include other local anesthetics [see Warnings and Precautions ( 5.4 )] : Examples of Drugs Associated with Methemoglobinemia Class Examples Nitrates/Nitrites nitric oxide, nitroglycerin, nitroprusside, nitrous oxide Local anesthetics articaine, benzocaine, bupivacaine, lidocaine, mepivacaine, prilocaine, procaine, ropivacaine,… (Ropivacaine label, Drug interactions)

  • Telmisartan and amlodipineangiotensin II receptor blocker (ARB)Moderate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • Treprostinilprostaglandin analogModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

  • Verapamilcalcium channel blockerModerate

    Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. (Isosorbide mononitrate label, Drug interactions)

  • VericiguatvasodilatorModerate

    The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. (Isosorbide mononitrate label, Drug interactions)

Minor mentions (9)

  • Dutasteride and tamsulosin5-alpha reductase inhibitorMinor

    Alpha-adrenergic antagonists and PDE-5 inhibitors are both vasodilators that can lower blood pressure. (Dutasteride and tamsulosin label, Warnings and precautions)

  • Other Cardiovascular Agents Enalapril has been used concomitantly with beta adrenergic-blocking agents, methyldopa, nitrates, calcium-blocking agents, hydralazine and prazosin without evidence of clinically significant adverse interactions. (Enalapril and hydrochlorothiazide label, Drug interactions)

  • EnalaprilatACE inhibitorMinor

    Other Cardiovascular Agents Enalaprilat injection, USP has been used concomitantly with digitalis, beta adrenergic-blocking agents, methyldopa, nitrates, calcium-blocking agents, hydralazine and prazosin without evidence of clinically significant adverse interactions. (Enalaprilat label, Drug interactions)

  • EpinephrinesympathomimeticMinor

    Drugs antagonizing pressor effects of epinephrine α-blockers, such as phentolamine Vasodilators, such as nitrates Diuretics Antihypertensives Ergot alkaloids Drugs potentiating pressor effects of epinephrine • Sympathomimetics • β-blockers, such as propranolol • Tricyclic anti-depressants • Monoamine oxidase (MAO) inhibitors • Catechol-O-methyl transferase (COMT)… (Epinephrine label, Drug interactions)

  • Finasteride5-alpha reductase inhibitorMinor

    …acetylsalicylic acid, α-blockers, angiotensin-converting enzyme (ACE) inhibitors, analgesics, anti-convulsants, beta-adrenergic blocking agents, diuretics, calcium channel blockers, cardiac nitrates, HMG-CoA reductase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, H 2 antagonists and quinolone anti-infectives without evidence of clinically… (Finasteride label, Drug interactions)

  • Other Agents: Lisinopril has been used concomitantly with nitrates and/or digoxin without evidence of clinically significant adverse interactions. (Lisinopril and hydrochlorothiazide label, Drug interactions)

  • MethohexitalbarbiturateMinor

    Post injury arterial injection of vasodilators and/or arterial infusion of parenteral fluids are generally regarded to be of no value in altering outcome. (Methohexital label, Warnings)

  • Silodosinalpha blockerMinor

    Alpha-adrenergic blockers and PDE5 inhibitors are both vasodilators that can lower blood pressure. (Silodosin label, Warnings and precautions)

  • Tamsulosinalpha blockerMinor

    Alpha-adrenergic blockers and PDE5 inhibitors are both vasodilators that can lower blood pressure. (Tamsulosin label, Warnings and precautions)

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Not medical advice. Severity reflects the label's wording, not your circumstances. A "major" flag can be routine under supervision and a "minor" one can matter at high doses. Ask a pharmacist.