Drug General Information (ID: DDI06MP1XK)
  Drug Name Isosorbide mononitrate Drug Info Selexipag Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Vasodilator Agents Agents For Pulmonary Hypertension
  Structure

 Mechanism of Isosorbide mononitrate-Selexipag Interaction (Severity Level: Moderate)
     Additive hypotensive effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Isosorbide mononitrate Selexipag
      Mechanism Hypotensive effects
Guanylate cyclase  Agonist
Hypotensive effects
Prostacyclin receptor  Agonist
      Key Mechanism Factor 1
Factor Name Guanylate cyclase soluble Structure Sequence
Protein Family Adenylyl cyclase class-4/guanylyl cyclase family
Protein Function
There are two types of guanylate cyclases: soluble forms and membrane-associated receptor forms. Activated by nitric oxide in the presence of magnesium or manganese ions.
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      Key Mechanism Factor 2
Factor Name Prostacyclin receptor
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Structure Sequence
MADSCRNLTYVRGSVGPATSTLMFVAGVVGNGLALGILSARRPARPSAFAVLVTGLAATDLLGTSFLSPAVFVAYARNSSLLGLARGGPALCDAFAFAMTFFGLASMLILFAMAVERCLALSHPYLYAQLDGPRCARLALPAIYAFCVLFCALPLLGLGQHQQYCPGSWCFLRMRWAQPGGAAFSLAYAGLVALLVAAIFLCNGSVTLSLCRMYRQQKRHQGSLGPRPRTGEDEVDHLILLALMTVVMAVCSLPLTIRCFTQAVAPDSSSEMGDLLAFRFYAFNPILDPWVFILFRKAVFQRLKLWVCCLCLGPAHGDSQTPLSQLASGRRDPRAPSAPVGKEGSCVPLSAWGEGQVEPLPPTQQSSGSAVGTSSKAEASVACSLC
Gene Name PTGIR
Uniprot ID PI2R_HUMAN
KEGG Pathway hsa:5739
Protein Family G-protein coupled receptor 1 family
Protein Function
Receptor for prostacyclin (prostaglandin I2 or PGI2). The activity of this receptor is mediated by G(s) proteins which activate adenylate cyclase.
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      Mechanism Description
  • Additive hypotensive effects by the combination of Isosorbide mononitrate and Selexipag 

Recommended Action
      Management While therapies that target the prostacyclin pathway have been used in combination with diuretics, antihypertensives, or other vasodilators in the management of pulmonary arterial hypertension, caution is recommended if they must be administered concurrently. If these drugs are used together, it is generally recommended that blood pressure be measured more frequently until a stable blood pressure pattern is observed. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their doctor if they experience dizziness, lightheadedness, syncope, orthostatic hypotension, or tachycardia.

References
1 Cerner Multum, Inc. "UK Summary of Product Characteristics.".
2 Product Information. Flolan (epoprostenol). Glaxo Wellcome, Research Triangle Park, NC.
3 Product Information. Remodulin (treprostinil). United Therapeutics Corp, Silver Spring, MD.