Drug General Information (ID: DDIFCOTSBK)
Drug Name			Isosorbide		Drug Info		Licorice		Drug Info
Drug Type		Small molecule				Natural product
Therapeutic Class		Antianginal Agents				Herbal Products
Structure

Mechanism of Isosorbide-Licorice Interaction (Severity Level: Moderate)
Antagonize the effect of antihypertensive agents Click to Show/Hide Mechanism Graph
Drug Name		Isosorbide				Licorice
Mechanism		Antihypertensive agent Guanylate cyclase  Agonist				Hypertensive effects Mineralocorticoid and renin-suppressing effects
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		Antagonize the effect of Isosorbide when combined with Licorice

Recommended Action
Management		Patients receiving antihypertensive therapy should avoid or limit the consumption of licorice-containing products. Even relatively moderate doses of licorice may be problematic in susceptible patients when ingested regularly for prolonged periods.

References
1	Stewart PM, Wallace AM, Valentino R, Burt D, Shackleton CH, Edwards CR "Mineralocorticoid activity of liquorice: 11-beta-hydroxysteroid dehydrogenase deficiency comes of age." Lancet 2 (1987): 821-4. [PMID: 2889032]
2	Cumming AM "Metabolic effects of licorice." Br Med J 1 (1977): 906
3	Epstein MT, Espiner EA, Donald RA, Hughes H "Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects." Br Med J 1 (1977): 488-90