Isosorbide mononitrate (ISMN) is a member of the nitrate family of drugs used to prevent angina (chest pain). It is available in immediate-release and extended-release products.
Taking sustained-release tablets of ISDN with a high-fat meal might increase the absorption of the drug.1 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.
In a double-blind trial, sustained-release ISMN plus oral NAC (2,400 mg twice per day) for two days led to significantly longer exercise time than ISMN plus placebo.3 This outcome suggests that NAC may have increased the efficacy of ISMN. There were no differences in side effects between the two groups.
Some persons taking nitroglycerin or isosorbide mononitrate may find that it loses efficacy over time. This is because the body adapts to the drug, a process known as developing tolerance. One study found that taking 2 grams three times daily of vitamin C can decrease this effect when nitroglycerin patches are simultaneously used.4 Similar benefits have been confirmed in another study.5 However, it should be noted that it is also possible to avoid tolerance to these drugs by simply changing the dosing schedule. People taking ISMN or nitroglycerin should talk with their pharmacists about avoiding drug tolerance.
1. 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.
2. 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.
3. Svendsen JH, Klarlund K, Aldershvile J, Waldorff S. N-acetylcysteine modifies the acute effects of isosorbide-5-mononitrate in angina pectoris patients evaluated by exercise testing. J Cardiovasc Pharmacol 1989;13:320-3.
4. Watanabe H, Kakihana M, Ohtsuka S, Sugishita Y. Randomized, double-blind, placebo-controlled study of the preventive effect of supplemental oral vitamin C on attenuation of development of nitrate tolerance. J Am Coll Cardiol 1998;31:1323-9.
5. Bassenge E, Fink N, Skatchkov M, Fink B. Dietary supplement with vitamin C prevents nitrate tolerance. J Clin Invest 1998;102:67-71.
Last Review: 04-29-2014
Copyright © 2014 Aisle7. All rights reserved. Aisle7.com
Please read the disclaimer about the limitations of the information provided here. Do NOT rely solely on the information in this article. The Aisle7 knowledgebase does not contain every possible interaction.
The information presented in Aisle7 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. Information expires June 2015.
Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.