Details of Drug Interaction

Details of Drug-Drug Interaction

 Drug General Information (ID: DDI2GS85VC)
  Drug Name Nortriptyline Drug Info Isosorbide mononitrate Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antidepressants Vasodilator Agents
  Structure

 Mechanism of Nortriptyline-Isosorbide mononitrate Interaction (Severity Level: Moderate)
     Additive hypotensive effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Nortriptyline Isosorbide mononitrate
      Mechanism 1 Antihypertensive agent Hypotensive effects
Guanylate cyclase  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.
    Click to Show/Hide
      Mechanism Description
  • Additive hypotensive effects by the combination of Nortriptyline and Isosorbide mononitrate 
      Mechanism 2 Hypotensive effects Hypotensive effects
Guanylate cyclase  Agonist
      Key Mechanism Factor 2
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.
    Click to Show/Hide
      Mechanism Description
  • Additive hypotensive effects by the combination of Nortriptyline and Isosorbide mononitrate 

Recommended Action
      Management Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Avoid alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References
1 Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6. [PMID: 2211552]
2 Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139. [PMID: 2005082]
3 Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1. [PMID: 1770159]