Drug General Information (ID: DDIV8FYP0K)
Drug Name			Isosorbide mononitrate		Drug Info		Nefazodone		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Vasodilator Agents				Antidepressants
Structure

Mechanism of Isosorbide mononitrate-Nefazodone Interaction (Severity Level: Moderate)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Isosorbide mononitrate				Nefazodone
Mechanism		Hypotensive effects Guanylate cyclase  Agonist				Potentiate the hypotensive effect of antihypertensive agents
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 Isosorbide mononitrate and Nefazodone

Recommended Action
Management		Caution and close monitoring for altered efficacy and safety are recommended if patients receive nefazodone with agents that can produce significant hypotension such as antihypertensive agents or vasodilators. Patients should be made aware of the possible side effects (e.g., dizziness, lightheadedness, orthostasis) and be cautioned about driving, operating machinery, or performing other hazardous tasks.

References
1	Product Information. Fycompa (perampanel). Eisai Inc, Teaneck, NJ.
2	Product Information. Serzone (nefazodone). Bristol-Myers Squibb, Princeton, NJ.
3	Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7. [PMID: 3725002]