Isorey Drug Interactions

Phosphodiesterase-5 inhibitors: Concomitant use of isosorbide dinitrate with phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil) may lead to pronounced hypotension and potentially life-threatening cardiovascular events. Therefore, isosorbide dinitrate must not be administered to patients receiving these agents. Acute therapy with isosorbide dinitrate must not be given within 24 hours of sildenafil or vardenafil intake, or within 48 hours of tadalafil intake.
Blood pressure-lowering agents: The hypotensive effect of isosorbide dinitrate may be potentiated by concurrent use of other blood pressure-lowering drugs, such as beta-blockers, calcium channel blockers, ACE inhibitors, vasodilators, monoamine oxidase inhibitors, neuroleptics, or tricyclic antidepressants, as well as by alcohol. Co-administration with ACE inhibitors or arterial vasodilators may be therapeutically desirable; however, if excessive hypotension occurs, dose adjustment of one or both agents should be considered.
Dihydroergotamine: Concomitant administration of isosorbide dinitrate may increase plasma concentrations of dihydroergotamine, potentially enhancing its hypertensive effects.
Riociguat: The use of isosorbide dinitrate with riociguat, a soluble guanylate cyclase stimulator, is contraindicated due to the risk of pronounced hypotension (see Contraindications).
Sapropterin: Sapropterin (tetrahydrobiopterin, BH4) is a cofactor for nitric oxide synthase. Caution is advised when sapropterin-containing medicines are used concomitantly with agents that induce vasodilation via nitric oxide pathways, including classical NO donors such as glycerol trinitrate, isosorbide dinitrate, or isosorbide 5-mononitrate.