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Can you take Isosorbide mononitrate with Teriparatide?

1 drug interaction and 28 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

isosorbide mononitrate teriparatide

Applies to: isosorbide mononitrate and teriparatide

Teriparatide may briefly lower your blood pressure after administration. Using teriparatide and isosorbide mononitrate together may increase this risk. You may experience symptoms such as lightheadedness when standing up, dizziness, or fast heartbeat. Preferably, take your injection of teriparatide in a place where you can sit or lie down. Talk to your doctor if you have any of these symptoms. You may need your blood pressure and heart rate checked more often to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

isosorbide mononitrate Alcohol (Ethanol)

Applies to: isosorbide mononitrate

Ethanol and isosorbide mononitrate may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, or changes in pulse or heart rate, especially when treatment is started, the dose is changed, or treatment is restarted. Tell your doctor promptly if these symptoms occur and seek urgent medical help if you faint or have severe dizziness. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Disease interactions

27 potential interactions Applies to: 25 conditions, including Vitamin D Deficiency, Heart Failure, Heart Attack, Hypotension, and Anemia.

Anemia

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Anemia.

Some manufacturers and medical references consider the use of nitrates and nitrites to be contraindicated in patients with severe anemia. Nitrates and nitrites can cause methemoglobinemia, primarily in high-dose intravenous therapy or acute poisoning and in patients with NADH reductase deficiency. However, elevations of methemoglobin may also occur with commonly used dosages. While probably not of routine clinical significance, the increases may be important in certain patient populations such as those with coronary insufficiency or anemia.

Aortic Stenosis

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Aortic Stenosis.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Brain Tumor

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Brain Tumor.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Cerebrovascular Insufficiency

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Cerebrovascular Insufficiency.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Constrictive Pericarditis

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Constrictive Pericarditis.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Dehydration

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Dehydration.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Glaucoma/Intraocular Hypertension

Minor:

isosorbide mononitrate

Isosorbide mononitrate has a minor potential interaction with Glaucoma/Intraocular Hypertension.

Some medical references state that organic nitrates and nitrites may increase intraocular pressure and should be used with caution in patients with glaucoma. However, the effect on intraocular pressure is variable and brief, and there is no evidence that these drugs precipitate narrow-angle glaucoma. Amyl nitrate typically may cause a slight rise of 3+ mm for several seconds followed by a fall in intraocular pressure for 10 to 20 minutes, the latter secondary to a fall in blood pressure. Nitroglycerin rarely produces ocular side effects, and oral nitroglycerin appears to have few to no significant ocular side effects.

Head Injury

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Head Injury.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Heart Attack

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Heart Attack.

The benefits of organic nitrates and nitrites in patients with acute myocardial infarction (AMI) or congestive heart failure have not been established and its use is not recommended in these settings. If used, it should be accompanied by careful clinical and hemodynamic monitoring to avoid the hazards of systemic hypotension and tachycardia, which in AMI can exacerbate myocardial ischemia. In general, oral or long-acting formulations of these drugs should not be used in the early management of AMI because of the difficulty in precisely controlling and rapidly terminating their hemodynamic effects should adverse reactions occur. Sublingual and other immediate- onset nitrates or nitrites should typically be avoided in suspected AMI with marked bradycardia or tachycardia, and should be used with extreme caution, if at all, in patients with right ventricular or inferior wall infarction. Rarely, sublingual nitroglycerin has produced hypotension accompanied by paradoxical bradycardia in patients with AMI and especially right ventricular infarction. The latter group of patients are also particularly dependent on adequate right ventricular preload to maintain cardiac output and can experience profound hypotension with nitrate or nitrite administration due to reduction of right ventricular preload.

Heart Failure

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Heart Failure.

The benefits of organic nitrates and nitrites in patients with acute myocardial infarction (AMI) or congestive heart failure have not been established and its use is not recommended in these settings. If used, it should be accompanied by careful clinical and hemodynamic monitoring to avoid the hazards of systemic hypotension and tachycardia, which in AMI can exacerbate myocardial ischemia. In general, oral or long-acting formulations of these drugs should not be used in the early management of AMI because of the difficulty in precisely controlling and rapidly terminating their hemodynamic effects should adverse reactions occur. Sublingual and other immediate- onset nitrates or nitrites should typically be avoided in suspected AMI with marked bradycardia or tachycardia, and should be used with extreme caution, if at all, in patients with right ventricular or inferior wall infarction. Rarely, sublingual nitroglycerin has produced hypotension accompanied by paradoxical bradycardia in patients with AMI and especially right ventricular infarction. The latter group of patients are also particularly dependent on adequate right ventricular preload to maintain cardiac output and can experience profound hypotension with nitrate or nitrite administration due to reduction of right ventricular preload.

Hemodialysis

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Hemodialysis.

The combined effect of organic nitrates or nitrites with hemodialysis, which often lowers blood pressure, can cause life-threatening hypotension. Therapy with these agents should be administered cautiously in patients requiring hemodialysis. The medication should be withheld before undergoing dialysis, and hemodynamic stability should be established prior to resumption of medication following dialysis. Nitroglycerin and isosorbide dinitrate are moderately dialyzed.

Hemorrhagic Stroke

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Hemorrhagic Stroke.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Hungry Bone Syndrome

Major:

teriparatide

Teriparatide has a major potential interaction with Hungry Bone Syndrome.

The use of teriparatide in patients with metabolic bone disease, other than osteoporosis is not recommended by the manufacturer.

Hypercalcemia

Major:

teriparatide

Teriparatide has a major potential interaction with Hypercalcemia.

Patients known to have an underlying hypercalcemic disorder, such as primary hyperparathyroidism, should not be treated with parathyroid hormone and its analogs because of the risk of exacerbating hypercalcemia.

Hyperparathyroidism

Major:

teriparatide

Teriparatide has a major potential interaction with Hyperparathyroidism.

Patients known to have an underlying hypercalcemic disorder, such as primary hyperparathyroidism, should not be treated with parathyroid hormone and its analogs because of the risk of exacerbating hypercalcemia.

Hypertrophic Cardiomyopathy

Moderate:

isosorbide mononitrate

Isosorbide mononitrate has a moderate potential interaction with Hypertrophic Cardiomyopathy.

Organic nitrates and nitrites may aggravate the angina associated with hypertrophic cardiomyopathy and should be administered cautiously in patients with this condition.

Hypotension

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Hypotension.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Moderate:

teriparatide

Teriparatide has a moderate potential interaction with Hypotension.

There have been reports of transient episodes of symptomatic orthostatic hypotension with the use of teriparatide in short-term clinical pharmacology studies. Caution is recommended when using this agent in patients at risk.

Neoplasm of Bone

Major:

teriparatide

Teriparatide has a major potential interaction with Neoplasm of Bone.

Parathyroid hormone and its analogs should not be used in patients who are at increased baseline risk for osteosarcoma. These agents should only be used if the potential benefits are considered to outweigh the potential risks. Monitor these patients according to clinical guidelines. Patients with bone metastases or a history of skeletal malignancies should not be treated with these agents.

Nephrolithiasis

Moderate:

teriparatide

Teriparatide has a moderate potential interaction with Nephrolithiasis.

Teriparatide should be used with caution in patients with active urolithiasis. If active or pre-existing hypercalciuria is suspected, measurement of urinary calcium excretion should be considered because of the potential to exacerbate urolithiasis in these patients.

Osteodystrophy

Major:

teriparatide

Teriparatide has a major potential interaction with Osteodystrophy.

The use of teriparatide in patients with metabolic bone disease, other than osteoporosis is not recommended by the manufacturer.

Paget's Disease

Major:

teriparatide

Teriparatide has a major potential interaction with Paget's Disease.

Parathyroid hormone and its analogs should not be used in patients who are at increased baseline risk for osteosarcoma. These agents should only be used if the potential benefits are considered to outweigh the potential risks. Monitor these patients according to clinical guidelines. Patients with bone metastases or a history of skeletal malignancies should not be treated with these agents.

Major:

teriparatide

Teriparatide has a major potential interaction with Paget's Disease.

The use of teriparatide in patients with metabolic bone disease, other than osteoporosis is not recommended by the manufacturer.

Pseudotumor Cerebri

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Pseudotumor Cerebri.

Organic nitrates and nitrites can increase cerebrospinal fluid pressure. Therapy with these agents should be administered cautiously, if at all, in patients with or at risk for intracranial hypertension, including those with cerebral hemorrhage, intracranial lesions, or recent head trauma.

Renal Dysfunction

Moderate:

teriparatide

Teriparatide has a moderate potential interaction with Renal Dysfunction.

No pharmacokinetic differences were identified in patients with mild or moderate renal impairment after a single dose of teriparatide. In patients with severe renal impairment, the AUC and half-life of teriparatide were increased by 73% and 77%, respectively. Care should be exercised in patients undergoing dialysis for chronic renal failure as no studies have been performed in this patient population.

Shock

Major:

isosorbide mononitrate

Isosorbide mononitrate has a major potential interaction with Shock.

Organic nitrates and nitrites may cause severe hypotension, syncope and shock, even with small doses. Hypotension induced by these agents may be accompanied by paradoxical bradycardia and increased angina pectoris. Therapy with nitrates and nitrites should be administered cautiously in patients who are volume-depleted or hypotensive (e.g., systolic blood pressure <90 mm Hg) or who, because of inadequate circulation to the brain or to other vital organs, would be unusually compromised by undue hypotension. Patients should be in a sitting or recumbent position during and immediately after drug administration, and monitored for symptoms of severe hypotension such as nausea, vomiting, weakness, pallor, perspiration, and syncope. Nitrate or nitrite therapy is considered contraindicated in patients with acute circulatory failure or shock.

Vitamin D Deficiency

Major:

teriparatide

Teriparatide has a major potential interaction with Vitamin D Deficiency.

The use of teriparatide in patients with metabolic bone disease, other than osteoporosis is not recommended by the manufacturer.

More resources

isosorbide mononitrate

A total of 239 drugs are known to interact with isosorbide mononitrate.

teriparatide

A total of 104 drugs are known to interact with teriparatide.

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.