Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction

Concurrent administration of drugs with blood pressure lowering properties, e.g. beta-blockers, calcium channel blockers, vasodilators, alprostadil, aldesleukin, ACE-inhibitors, monoamine oxidase inhibitors, angiotensin II receptor antagonists etc. and/or alcohol may potentiate the hypotensive effect of Monolong. This may also occur with neuroleptics and tricyclic antidepressants.

The concurrent intake of isosorbide mononitrate with ACE-inhibitors or arterial vasodilators could be a desirable interaction, unless the antihypertensive effects are excessive in which case consider reducing the dose of one or both drugs.

Any blood pressure lowering effect of Monolong will be increased if used together with phosphodiesterase type-5 inhibitors which are used for erectile dysfunction (see 4.3 and 4.4). This might lead to life threatening cardiovascular complications. Patients who are on Monolong therapy therefore must not use phosphodiesterase type-5 inhibitors (e.g. sildenafil, tadalafil, vardenafil).

The use of isosorbide mononitrate with riociguat, a soluble guanylate cyclase stimulator, is contraindicated (see section 4.3) since concomitant use can cause hypotension.

Reports suggest that concomitant administration of Monolong may increase the blood level of dihydroergotamine and its hypertensive effect.

Sapropterine (Tetrahydrobiopterine, BH4) is a cofactor for nitric oxide synthetase.

Caution is recommended during concomitant use of sapropterine-containing medicine with all agents that cause vasodilation by affecting nitric oxide (NO) metabolism or action, including classical NO donors (e.g. glyceryl trinitrate (GTN), isosorbide dinitrate (ISDN), isosorbide 5-mononitrate (5-ISMN) and others).