Pounding headaches are by far the most common problem associated to nitrates; however, the headaches disappear in many subjects when the drug is used regularly. Hypotensive complaints (especially with orthostatism) with vertigo, weakness and palpitations are relatively frequent. Bradycardia, flushed skin and skin rashes, on the other hand, are rare. Very rarely a massive hypotension accompanied by a collapse may occur.

When isosorbide dinitrate is administered continually a nitrate tolerance that entails a loss of efficacy develops within 10 days. This effect does not occur if a daily 10-hour therapy-free interval is observed.

Isosorbide Dinitrate: Interactions

ISDN reinforces the hypotensive effect of antihypertensive agents. Combined with alcohol, ISDN can cause a sudden drop of the blood pressure and a collapse. ISDN increases the bioavailability of dihydroergotamine.

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