Drug interactions
isosorbide mononitrate + metoprolol
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Overview
Additive blood pressure–lowering effects increase risk of symptomatic hypotension/orthostasis and dizziness; beta-blocker may blunt nitrate-induced reflex tachycardia, potentially contributing to bradycardia.
Mechanism of action
Pharmacodynamic: Nitrate-mediated venous and arterial dilation lowers preload/afterload; beta-1 blockade reduces heart rate/contractility and blunts reflex sympathetic response, cumulatively lowering blood pressure.
Clinical management
Use together with caution; initiate and titrate doses gradually; monitor BP (sitting/standing) and heart rate; counsel on orthostatic precautions; reduce or hold dose if symptomatic hypotension, syncope, or bradycardia occurs; review other BP-lowering agents and volume status.
Drug reference
References
- Imdur (isosorbide mononitrate) Prescribing Information — FDA Label
- Metoprolol Tartrate (Lopressor) Prescribing Information — FDA Label
- Isosorbide mononitrate: Drug Information — Lexicomp
Frequently asked questions
Can I take isosorbide mononitrate with metoprolol?
The interaction is rated: Moderate. Additive blood pressure–lowering effects increase risk of symptomatic hypotension/orthostasis and dizziness; beta-blocker may blunt nitrate-induced reflex tachycardia, potentially contributing to bradycardia.
How serious is the interaction between isosorbide mononitrate and metoprolol?
The interaction is rated: Moderate. Evidence level: Moderate.
How is the interaction between isosorbide mononitrate and metoprolol managed?
Use together with caution; initiate and titrate doses gradually; monitor BP (sitting/standing) and heart rate; counsel on orthostatic precautions; reduce or hold dose if symptomatic hypotension, syncope, or bradycardia occurs; review other BP-lowering agents and volume status.
Why do isosorbide mononitrate and metoprolol interact?
Pharmacodynamic: Nitrate-mediated venous and arterial dilation lowers preload/afterload; beta-1 blockade reduces heart rate/contractility and blunts reflex sympathetic response, cumulatively lowering blood pressure.
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