Drug General Information (ID: DDIVY6UELT)
  Drug Name Treprostinil Drug Info Isosorbide mononitrate Drug Info
  Drug Type Small molecule Small molecule
  Therapeutic Class Antihypertensive Agents Vasodilator Agents
  Structure

 Mechanism of Treprostinil-Isosorbide mononitrate Interaction (Severity Level: Moderate)
     Additive hypotensive effects Click to Show/Hide Mechanism Graph
Could Not Find 2D Structure
      Drug Name Treprostinil Isosorbide mononitrate
      Mechanism Antihypertensive agent
Prostaglandin receptor  Agonist
Hypotensive effects
Guanylate cyclase  Agonist
      Key Mechanism Factor 1
Factor Name Prostaglandin D2 receptor
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Structure Sequence
MKSPFYRCQNTTSVEKGNSAVMGGVLFSTGLLGNLLALGLLARSGLGWCSRRPLRPLPSVFYMLVCGLTVTDLLGKCLLSPVVLAAYAQNRSLRVLAPALDNSLCQAFAFFMSFFGLSSTLQLLAMALECWLSLGHPFFYRRHITLRLGALVAPVVSAFSLAFCALPFMGFGKFVQYCPGTWCFIQMVHEEGSLSVLGYSVLYSSLMALLVLATVLCNLGAMRNLYAMHRRLQRHPRSCTRDCAEPRADGREASPQPLEELDHLLLLALMTVLFTMCSLPVIYRAYYGAFKDVKEKNRTSEEAEDLRALRFLSVISIVDPWIFIIFRSPVFRIFFHKIFIRPLRYRSRCSNSTNMESSL
Gene Name PTGDR
Uniprot ID PD2R_HUMAN
KEGG Pathway hsa:5729
Protein Family G-protein coupled receptor 1 family
Protein Function
Receptor for prostaglandin D2 (PGD2). The activity of this receptor is mainly mediated by G(s) proteins that stimulate adenylate cyclase, resulting in an elevation of intracellular cAMP. A mobilization of calcium is also observed, but without formation of inositol 1,4,5-trisphosphate (By similarity). Involved in PLA2G3-dependent maturation of mast cells. PLA2G3 is secreted by immature mast cells and acts on nearby fibroblasts upstream to PTDGS to synthesize PGD2, which in turn promotes mast cell maturation and degranulation via PTGDR (By similarity).
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      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.
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      Mechanism Description
  • Additive hypotensive effects by the combination of Treprostinil and Isosorbide mononitrate 

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.