Vitamin B6 can bind to hydralazine to form a complex that is excreted in the urine, increasing vitamin B6 loss.1 This may lead to vitamin B6 deficiency.2 People taking hydralazine should consult with their doctor to discuss the possibility of vitamin B6 supplementation.
Taking sustained-release tablets of ISDN with a high-fat meal might increase the absorption of the drug.3 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.
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.5 , 6 Another controlled study revealed that intravenous NAC enhanced the beneficial effects of ISDN on heart function.7 Therefore, people taking isosorbide dinitrate might benefit from supplemental NAC.
1. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 131–2.
2. Raskin NH, Rishman RA. Pyridoxine-deficiency neuropathy due to hydralazine. N Engl J Med 1965;273:1182–5.
3. 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.
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. 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.
6. 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.
7. 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.
Last Review: 05-01-2013
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