Montra Drug Interactions

Concomitant administration with PDE-5 inhibitors can potentiate the vasodilatory effect of organic nitrates/nitrites resulting in life-threatening hypotension with syncope or myocardial infarction and death. Thus, PDE-5 inhibitors should not be given to patients on existing therapy with ISMN (see Precautions).
Dihydroergotamine may counteract the coronary vasodilatory effect of nitrates. Use concomitantly with caution since this may increase risk of angina precipitation.
Adding ISMN to propranolol treatment in patients with cirrhosis and portal hypertension led to a marked fall in portal pressure, reduction in hepatic blood flow, cardiac output and mean arterial blood pressure.
Patients receiving other vasodilators, calcium-channel blockers, angiotensin-converting enzyme (ACE) inhibitors, β-blockers, diuretics, antihypertensives, tricyclic antidepressants, major tranquilizers, phenothiazines and nitrates/nitrites should be observed for possible additive hypotensive effects. Dose adjustments of either the nitrate/nitrite or the other agent with hypotensive activity may be necessary to avoid orthostatic hypotension during concomitant use.
Alcohol may enhance sensitivity to the hypotensive effects of nitrates.