Clinical decision-support only. For use by licensed dental professionals. Not a substitute for professional judgment or a complete drug reference. Always verify with primary sources.
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Medication

Isosorbide dinitrate / mononitrate

Nitrate (antianginal vasodilator)

Brand names: Isordil, Imdur

Oral health effects

  • Sublingual burning; nitrate–PDE5 interaction

    Limited direct oral effects; sublingual forms can cause local burning. The key concern is a dangerous interaction with PDE5 inhibitors (severe hypotension).

    Clinical management: Avoid combining with sildenafil/tadalafil; have the patient's nitroglycerin available for angina.

  • Dizziness on standing (orthostatic hypotension)

    Transient lightheadedness, sometimes related to blood-pressure changes, can occur; hypotension is infrequent but occasionally severe enough to stop therapy, and syncope has been reported.

    Clinical management: Raise the chair back slowly at the end of the appointment, let the patient sit upright for 1–2 minutes before standing, and steady them as they get up. Take extra care in older patients, after long supine procedures and when other blood-pressure-lowering drugs are taken.

Sources

  1. Adverse drug events in the oral cavity. Yuan A, Woo SB. Oral surgery, oral medicine, oral pathology and oral radiology, 2015.
  2. Isosorbide dinitrate prescribing information (FDA label) AvPAK / DailyMed, 2026.