Isosorbide mononitrate (ISMN) is a member of the nitrate family of drugs used to prevent Reference angina (chest pain). It is available in immediate-release and extended-release products.
Common brand names:Imdur, IMSO, Monoket
Summary of Interactions with Vitamins, Herbs, & Foods
Replenish Depleted Nutrients
Reduce Side Effects
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.1 This outcome suggests that NAC may have increased the efficacy of ISMN. There were no differences in side effects between the two groups.
Potential Negative Interaction
Some persons taking Reference 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.2 Similar benefits have been confirmed in another study.3 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. 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.
2. 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.
3. 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: 11-07-2012
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