trates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
Riociguat: Coadministration of riociguat and nitrates or nitric oxide donors (e.g., amyl nitrite) is contraindicated due to the risk of hypotension. The blood pressure lowering effect of sublingual nitroglycerin was potentiated when administered 4 and 8 hours after riociguat. Syncope was reported in some patients.
Ritodrine: Concomitant use of nitrates with sympathomimetics can result in antagonism of the antianginal effects of nitrates. In addition, amyl nitrite can block the alpha-adrenergic effects of epinephrine, possibly precipitating tachycardia and severe hypotension.
Ropivacaine: Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Thus, patients receiving antihypertensive agents may experience additive hypotensive effects.
Rosiglitazone: The concomitant use of nitrates with rosiglitazone is not recommended. An increased risk of myocardial ischemia was observed in a subset of patients receiving nitrates with rosiglitazone. Most patients that were using nitrates had preexisting coronary artery disease. In patients with coronary artery disease that were not on nitrates, rosiglitazone therapy did not increase the risk of myocardial ischemia.
Sincalide: Sincalide-induced gallbladder ejection fraction may be affected by concurrent nitrates. False study results are possible in patients with drug-induced hyper- or hypo-responsiveness; thorough patient history is important in the interpretation of procedure results.
Sympathomimetics: Concomitant use of nitrates with sympathomimetics can result in antagonism of the antianginal effects of nitrates. In addition, amyl nitrite can block the alpha-adrenergic effects of epinephrine, possibly precipitating tachycardia and severe hypotension.
Tetracaine: Local anesthetics may cause additive hypotension in combination with antihypertensive agents. Use extreme caution with the concomitant use of tetracaine and antihypertensive agents or rapid-onset vasodilators, such as nitrates.
Thiazide diuretics: Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
Treprostinil: Concomitant use of nitrates with other antihypertensive agents can cause additive hypotensive effects. Dosage adjustments may be necessary.
PREGNANCY AND LACTATION
Pregnancy
Isosorbide dinitrate (ISDN) is classified as FDA pregnancy risk category C. Animal studies have shown no hazard at doses approximating usual human dosage. At oral doses 35 and 150 times the daily Maximum Recommended Human Dose (MRHD), isosorbide dinitrate has been shown to cause a dose related increase in embryotoxicity (increase in mummified pups) in rabbits. Human data are limited. Limited case reports exist of the successful use of nitrates for cardiac ischemia during pregnancy when necessary; these reports do not indicate the possibility of adverse effects resulting from the use of nitrates during pregnancy. Safety in pregnancy however, has not been established. For chronic anti-anginal therapy, other drugs (e.g., cardioselective beta-blockers) may also be considered. In making the decision to administer ISDN during pregnancy, the potential risks to the fetus must be weighed against the potential benefits to the mother.
It is not known whether isosorbide dini |
