Isosorbide Dinitrate, Hydralazine & Nutrient Depletion
Also searched as BiDil. What the clinical evidence reports, what it may mean, and what to discuss with your pharmacist.
Isosorbide Dinitrate, Hydralazine has been associated with depletion of VITAMIN B6 and COENZYME Q10. This does not mean a deficiency will occur — it means these are worth knowing about and, if you take Isosorbide Dinitrate, Hydralazine long-term, worth raising with your pharmacist or healthcare provider.
Take more than one medication? Open the checker with Isosorbide Dinitrate, Hydralazine pre-loaded and add the rest to see overlapping nutrient signals.
Reported nutrient depletions with Isosorbide Dinitrate, Hydralazine
Each record below is shown as published in our licensed clinical database, with its evidence rating and citations. Expand a section for food sources and talking points.
VITAMIN B6
Moderate DepletionHYDRALAZINE
Hydralazine can cause vitamin B6 deficiency in some patients, probably by reacting with pyridoxal phosphate to form an inactive hydrazine, which is excreted. Give vitamin B6 supplements to people taking hydralazine who develop early signs of peripheral neuropathy, such as paresthesias, numbness, and tingling. For information on foods that are rich in vitamin B6, see our chart.
Hydralazine, one of the two medications in this combination, can interfere with vitamin B6, which your body uses for nerve health, energy metabolism, and making red blood cells. The likely reason is that hydralazine chemically binds to the active form of B6 in your body, turning it into a compound your kidneys then flush out. Because this is rated as moderate depletion, long-term users have a real enough chance of running low that it is worth watching for early warning signs like tingling or numbness in the hands or feet. If you notice anything like that, bring it up with your pharmacist or doctor before assuming it is related.
What Vitamin B6 does & food sources
Vitamin B6 is involved in protein metabolism, neurotransmitter production, and red blood cell formation.
Common food sources:
- Poultry and fish
- Potatoes and starchy vegetables
- Bananas
- Fortified cereals
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
With some medications (for example, isoniazid), B6 is intentionally co-prescribed — follow your prescriber's plan. Otherwise, ask whether testing or supplementation is appropriate if you have symptoms like numbness or tingling.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
Paradoxically, long-term high-dose B6 can itself cause nerve symptoms — this is a nutrient where more is definitely not better.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Avoid high-dose B6 without medical guidance; sustained high intakes can cause neuropathy.
Learn more about this nutrient: Vitamin B6 — uses, safety & interactions
References (3)
- Shils ME, Olson JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease. 9th ed. Baltimore, MD: Williams & Wilkins, 1999.
- Raskin HN, Fishman RA. Pyridoxine-deficiency neuropathy due to hydralazine. N Engl J Med 1965;273:1182-5. PubMed
- Kastrup EK. Drug Facts and Comparisons. 1998 ed. St. Louis, MO: Facts and Comparisons, 1998.
COENZYME Q10
Insufficient EvidenceANTIHYPERTENSIVE DRUGS
Some antihypertensive drugs, including beta blockers, diazoxide, hydralazine, and others, appear to inhibit coenzyme Q10 enzyme activity and may decrease endogenous levels of coenzyme Q10. However, it is not clear if this reduction is clinically significant. There is no reliable evidence that coenzyme Q10 depletion contributes to antihypertensive drug side effects.
Coenzyme Q10 is a natural compound your cells use to produce energy, and it also acts as an antioxidant. Hydralazine, one of the two drugs in this combination, appears to interfere with enzymes that help your body make or use coenzyme Q10, which could nudge levels down over time. That said, the evidence here is really preliminary, and right now it is not clear whether any drop in levels actually causes problems in real patients. If you have questions or are thinking about a CoQ10 supplement, your pharmacist or doctor is the right person to talk it through with.
What Coenzyme Q10 (CoQ10) does & food sources
CoQ10 helps cells produce energy and acts as an antioxidant; heart and muscle tissue use it heavily.
Common food sources:
- Organ meats and fatty fish
- Whole grains
- Nuts and seeds
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
What to discuss with your clinician
There is no routine blood test for CoQ10 in everyday practice. If you have new, unexplained muscle symptoms on a medication linked to CoQ10 (statins are the best-known example), talk to your prescriber before changing anything — symptoms have many possible causes and your prescriber has several options.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Supplement considerations
CoQ10 is generally well tolerated, but evidence for supplementing (for example, for statin muscle symptoms) is mixed. It may also modestly affect warfarin — check with your pharmacist before combining.
Do not start or stop medications or supplements without professional guidance — supplements can interact with prescription medications.
HelloPharmacist pharmacist-reviewed education — separate from the licensed record above.
Caution: Do not stop a prescribed medication because of this association — discuss any symptoms with your prescriber first.
Learn more about this nutrient: Coenzyme Q10 — uses, safety & interactions
References (1)
- Kishi T, Kishi H, Watanabe T, et al. Bioenergetics in clinical medicine. XI. Studies on coenzyme Q and diabetes mellitus. J Med 1976;7:307-21.
This tool is educational and is not a substitute for professional medical advice. An association is not a diagnosis and does not mean a deficiency will occur. Always talk to your pharmacist or healthcare provider before starting, stopping, or changing any medication or supplement.
Disclaimer: This checker finds which nutrients might be depleted by prescription or over-the-counter medications. Each nutrient depletion issue is rated based on clinical significance. Use your own professional judgment prior to making clinical decisions.© 2026 Therapeutic Research Center Licensed records refresh weekly · last updated July 3, 2026.
More about Isosorbide Dinitrate, Hydralazine
What drug-induced nutrient depletion means
Some medications can, over time, lower the levels of certain vitamins, minerals, or other nutrients — through reduced absorption, increased loss, or changes in how the body uses them.
Association is not deficiency
An entry here means a depletion has been reported or studied — not that it happens to everyone, or that you are deficient. Dose, duration, diet, and your own health all matter.
Evidence varies by pair
Some drug–nutrient links (like metformin and vitamin B12) are well studied; others rest on limited or preliminary research. Each entry shows the evidence rating from our licensed clinical database.
When to ask about labs
If you take an associated medication long-term, ask your healthcare provider whether monitoring is appropriate for you. Not everyone needs testing — your provider can weigh your dose, duration, and symptoms.
Don't self-supplement blindly
Supplements are not risk-free: some can interact with medications, and some (like potassium or magnesium) can be risky with kidney disease. Talk to your pharmacist before adding anything.
Never stop a medication over this
These medications are prescribed for good reasons, and the benefit usually far outweighs a manageable nutrient consideration. Any change belongs in a conversation with your prescriber.
Food first, usually
For many nutrients, a varied diet covers the gap. Each entry lists common food sources; a supplement is a decision to make with your pharmacist or provider, not a default.
Isosorbide Dinitrate, Hydralazine & nutrients: FAQs
Does Isosorbide Dinitrate, Hydralazine deplete VITAMIN B6?
Should I take a supplement because I take Isosorbide Dinitrate, Hydralazine?
Should I stop taking Isosorbide Dinitrate, Hydralazine?
Where does this information come from?
Questions about Isosorbide Dinitrate, Hydralazine and your nutrition?
Ask a licensed pharmacist — free, no appointment needed.
Sources & How We Checked
Nutrient depletion records for Isosorbide Dinitrate, Hydralazine are evidence-graded and sourced from the Natural Medicines database, and are displayed as published with their citations.
- Natural Medicines (Therapeutic Research Center) — Evidence-graded clinical reference for drug-induced nutrient depletions, supplements, and interactions — the basis for this page.
- MedlinePlus, U.S. National Library of Medicine — NIH consumer drug information, used for medication overviews across the site.
Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.