NutriStack
Isosorbide Mononitrate and NAC, a caution.
NAC may potentiate organic nitrate effects, increasing the chance of dizziness, severe headache, flushing, or symptomatic hypotension. Evidence is strongest for nitroglycerin and isosorbide dinitrate, so this is a class-based caution for isosorbide mononitrate.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
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What the row says.
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At a glance
- Substances
- Isosorbide Mononitrate and NAC
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. NAC may potentiate organic nitrate effects, increasing the chance of dizziness, severe headache, flushing, or symptomatic hypotension. Evidence is strongest for nitroglycerin and isosorbide dinitrate, so this is a class-based caution for isosorbide mononitrate.
Mechanism. NAC supplies sulfhydryl groups that can enhance nitrate-mediated nitric oxide signaling. Clinical studies show potentiation of nitroglycerin and isosorbide dinitrate hemodynamic effects, supporting caution across organic nitrate therapy.
Recommendation. Do not add NAC to isosorbide mononitrate therapy without prescriber approval. If both are intentionally used, monitor blood pressure and report severe headache, lightheadedness, fainting, or chest-pain changes.
Sources (2)
- Mehra A, Shotan A, Ostrzega E, et al. Potentiation of isosorbide dinitrate effects with N-acetylcysteine in patients with chronic heart failure. Circulation. 1994;89(6):2595-2600. PMID 8205670
- Iversen HK. N-acetylcysteine enhances nitroglycerin-induced headache and cranial arterial responses. Clinical Pharmacology and Therapeutics. 1992;52(2):125-133. PMID 1505148
Stack Score
How this pair moves the number.
Effect on the composite score
If both Isosorbide Mononitrate and NAC are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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