Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. isosorbide mononitrate, bupivacaine implant. Isosorbide mononitrate conventional tablets, peak: 0.51 hour. Tape applicator in place. Prophylactic management in situations likely to provoke angina attacks in patients who fail to respond to sublingual nitroglycerin: 2.55 mg of isosorbide dinitrate should be placed under the tongue approximately 15 minutes prior to engaging in such activities. The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. cenobamate will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 2 0 obj Avoid or Use Alternate Drug. Use Caution/Monitor. Clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), should take a careful history so that concomitant use of organic nitrates or nitrites with selective PDE inhibitors can be avoided. It does not work fast enough to relieve the pain of an angina attack that has already started. isosorbide mononitrate increases effects of ergoloid mesylates by decreasing metabolism. rifabutin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. and formulary information changes. Monitor Closely (1)bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. Prophylactic management in situations likely to provoke angina attacks in patients who fail to respond to sublingual nitroglycerin: place 2.55 mg of isosorbide dinitrate under the tongue about 15 minutes prior to engaging in such activities. Administer extended-release tablets with adequate amounts of fluid (e.g., 120 mL) on arising in the morning. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. The above information is provided for general Use Caution/Monitor. Both drugs lower blood pressure. Monitor Closely (1)lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. DOSAGE AND ADMINISTRATION As noted above (CLINICAL PHARMACOLOGY), controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. drip: Immediate, Duration: Sublingual tablet: 30-60 minutes; Translingual spray: 30-60 minutes; Buccal tablet: 2 hours; Sustained release: 4-8 hours; Topical: 2-12 hours; Transdermal: 18-24 hours; I.V. Minor/Significance Unknown. Some conditions may become worse when the drug is suddenly stopped. Potentially fatal hypotension. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. If unavoidable, reduce CYP3A substrate dose according to product labeling. This dose should be increased to 10 mg by the second or third day of therapy. The drug comparisons information provided does not cover every potential use, warning, drug interaction, side effect, or adverse or allergic reaction. Use Caution/Monitor. Transient flushing may occur with the nitrates, and inhalation of amyl nitrite commonly causes cutaneous flushing of the head, neck, and clavicular area. Primarily reduces cardiac oxygen demand by decreasing preload (left ventricular end-diastolic pressure); may modestly reduce afterload; dilates coronary arteries and improves collateral flow to ischemic regions. tetracaine, isosorbide mononitrate. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2RydWcvaW1kdXItbW9ub2tldC1pc29zb3JiaWRlLW1vbm9uaXRyYXRlLTM0MjI3NQ==, View explanations for tiers and Modify Therapy/Monitor Closely. Minor/Significance Unknown. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. If relief is not attained after a single dose during an acute attack, may give additional doses at 5- to 10-minute intervals; give no more than 3 doses in a 15- to 30-minute period. Monitor Closely (1)istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor (1)cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This effect was not observed with istradefylline 20 mg/day. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. (See Tolerance and Dependence under Cautions.). Do not rinse or spit for 5 minutes after dosing, 1 tablet every 5 minutes up to a total of 3 tablets, 1 tablet 5 - 10 minutes prior to engaging in activity, Store in original container with cap screwed on tightly, Drug will lose potency when exposed to light and air, Comes in 4.9g (60 sprays) and 12g (200 sprays) bottle. Avoid or Use Alternate Drug. It will remain primed for 6 weeks. Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. fedratinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Importance of instructing patients receiving isosorbide dinitrate for relief of acute attacks of angina pectoris to consult a clinician or go to a hospital emergency room immediately if chest pain is not relieved after 3 doses approximately every 5 minutes, because inability to relieve chest pain may indicate acute MI. Importance of clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), to take a careful history so that concomitant use with selective PDE inhibitors can be avoided. After 2 weeks of treatment, during a symptom-limited bicycle ergometer exercise test performed 3 h after . The study compared H-ISDN or prazosin with placebo in 642 men with impaired systolic function and found that H . imdur dose imdur vs nitroglycerinNov 1, 2011 . The approximate onset and duration of action of various dosage forms of isosorbide dinitrate (ISDN) and isosorbide mononitrate (ISMN) are as follows: Onset and duration of action following intrabuccal administration are probably similar to those after sublingual administration of isosorbide dinitrate. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed. This drug is available at the lowest co-pay. phenobarbital will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension. The recommended starting dose of IMDUR Tablets is 30 mg (given as a single 30 mg tablet or as 1/2 of a 60 mg tablet) or 60 mg (given as a single tablet) once daily. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). It works by relaxing and widening blood vessels so blood can flow more easily to the heart.This medication will not relieve chest pain once it occurs. Use Caution/Monitor. provider for the most current information. larotrectinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Available for Android and iOS devices. The patient should be sitting immediately after sublingual or intrabuccal administration. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Use Caution/Monitor. Manage and view all your plans together even plans in different states. May repeat in 5 minutes if needed. Serious - Use Alternative (1)lofexidine, isosorbide mononitrate. Dilatation of the coronary arteries also occurs. Eccentric dosing with isosorbide-5-mononitrate in angina pectoris. ~}xp%0Vg^r3WT_a-~qvQD]dvo{,Z@${ssJC j(2GW`_? Isosorbide mononitrate (ISMN), an organic nitrate and the major biologically active metabolite of isosorbide dinitrate (ISDN), is a vasodilator with effects on both arteries and veins. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. By clicking send, you acknowledge that you have permission to email the recipient with this information. We comply with the HONcode standard for trustworthy health information. commonly, these are "non-preferred" brand drugs. Ask your doctor before using any headache pain medication. Minor (1)anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. %H$Z7. Use Caution/Monitor. To avoid development of tolerance to nitroglycerin, drug-free intervals of 10 - 12 hours are known to be sufficient; shorter intervals have not been well studied. In one small study (N=49), severe kidney disease (CrCl 5 - 28 ml/min) did not affect hydralazine pharmacokinetics. Adjust dosage of CYP3A4 substrates, if clinically indicated. % Use Caution/Monitor. Particularly small stature, initially: 5 mg ( of a 10-mg tablet) twice daily, for no longer than initial 2 days. Importance of informing patients of other important precautionary information. Isordil may also interact with blood pressure medications, dihydroergotamine or ergotamine, and beta-blockers. Use entire contents of foilpac to obtain full dose and discard immediately after use. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low blood pressure.This drug may make you dizzy. The onset of action of transdermal nitroglycerin is not sufficiently rapid for this product to be useful in aborting an acute anginal episode. Lencapavir may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates. Either increases effects of the other by pharmacodynamic synergism. bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Mechanism: additive vasodilation. Monitor Closely (1)efavirenz will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Both Imdur and Isordil may interact with erectile dysfunction medications and calcium channel blockers. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. IMDUR, generics Dosage Forms 100 mg/250 mL premixed bottle - UHN Note: 0.84 mL alcohol per 100 mL solution 100 mcg/mL 200 mcg/mL 400 mcg/mL 10 mg/10 mL . Minoxidil can exacerbate fluid retention in kidney disease. Either increases effects of the other by additive vasodilation. Contraindicated. Isosorbide mononitrate - Some of our experts prefer isosorbide mononitrate to dinitrate. Hydralazine undergoes extensive liver metabolism. STORAGE: Store at room temperature away from light and moisture. Use Caution/Monitor. Comes in 4.1g (90 sprays) and 8.5g (230 sprays) bottle. cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Parker JD. fosphenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid or Use Alternate Drug. It is not known if Isordil affects the fetus in pregnant women or if it occurs in breast milk. Adjust dose of drugs that are CYP3A4 substrates as necessary. . informational and educational purposes only. conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Prolonged use of oral nitrates has been associated with the development of tolerance to the hemodynamic and antianginal effects and possibly with cross-tolerance to sublingual nitrates. Medically reviewed by Drugs.com. Avoid or Use Alternate Drug. Isosorbide dinitrate used in fixed combination with hydralazine (BiDil) as adjunct to standard therapy for the treatment of heart failure in self-identified black patients to improve survival, decrease rate of hospitalization for worsened heart failure, and improve patient-reported functional status. SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, and flushing may occur as your body adjusts to this medication. Modify Therapy/Monitor Closely. Allow 48h after last tadalafil dose before nitrate administration. Risk of increased SBP, angina pectoris. Controlled studies in pregnant women show no evidence of fetal risk. Modify Therapy/Monitor Closely. nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. dabrafenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood pressure) should be done while you are taking this medication. Select one or more newsletters to continue. efavirenz will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Tight, light-resistant containers at 25C; may be exposed to 1530C. Manufacturers of selective PDE inhibitors (e.g., sildenafil, tadalafil, vardenafil) state that the drugs are contraindicated in patients receiving organic nitrates or nitrites in any form (e.g., orally, sublingually, transmucosally, parenterally), given regularly or intermittently, or nitric oxide donors since severe, potentially fatal hypotensive episodes can occur. Not known whether geriatric patients respond differently than younger patients. elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Thus, one appropriate dosing schedule for NITRO-BID would begin with two daily 1/2- inch (7.5 mg) doses, one applied on rising in the morning and one applied six hours later. Subsequent studies discovered that a chemical reaction between . Avoid or substitute another drug for these medications when possible. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Serious - Use Alternative (1)voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Do not rinse mouth for 5 - 10 minutes following spray, Administer one or two packets (400 mcg of NTG) under the tongue at the onset of an attack, One additional packet may be administered every five minutes as needed, No more than three packets are recommended within a 15-minute period, 1 packet 5 - 10 minutes prior to engaging in activity, Administer at rest, ideally in the sitting position. Monitor Closely (1)belzutifan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Drug class: Antianginal agents. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. 2 0 obj Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Monitor Closely (1)cenobamate will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. commonly, these are "preferred" (on formulary) brand drugs. Please confirm that you would like to log out of Medscape. Avoid or Use Alternate Drug. The observed clearance rates (close to 1 L/kg/min) greatly exceed hepatic blood flow; known sites of extrahepatic metabolism include red blood cells and vascular walls. crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Nitrates in the management of acute coronary syndrome. Isosorbide dinitrate or mononitrate is used for the acute relief of angina pectoris, for prophylactic management in situations likely to provoke angina attacks, and for long-term prophylactic management of angina pectoris. Avoid or Use Alternate Drug. Each day, take the first dose when you wake up, then take the second dose 7 hours later. Doses used in clinical trials have ranged from 1/2 inch (1.3 cm; 7.5 mg) to 2 inches (5.1 cm; 30 mg), typically applied to 36 square inches (232 square centimeters) of truncal skin. Fexinidazole inhibits CYP3A4. It has not been studied in liver disease. Consult your pharmacist or local waste disposal company. In one well-controlled clinical trial, subjects receiving nitroglycerin appeared to exhibit a rebound or withdrawal effect, so that their exercise tolerance at the end of the daily drug-free interval was less than that exhibited by the parallel group receiving placebo. (See Geriatric Patients under Dosage.). Your list will be saved and can be edited at any time. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia. The first products in the metabolism of nitroglycerin are inorganic nitrate and the 1,2- and 1,3-dinitroglycerols. isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism. Risk of increased SBP, angina pectoris. Heart Disease: Symptoms, Signs, and Causes. Adjust dose according to prescribing information if needed. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Monitor Closely (1)encorafenib, isosorbide mononitrate. Serious - Use Alternative (1)tucatinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Fexinidazole inhibits CYP3A4. The data are consistent, however, in suggesting that nitroglycerin levels rise to steady state within an hour or so of application of ointment, and that after removal of nitroglycerin ointment, levels wane with a half-life of about half an hour. Contraindicated (1)isosorbide mononitrate, vardenafil. Most Several well-controlled clinical trials have used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates. After several days, the dosage may be increased to 120 mg (given as a single 120 mg tablet or as two 60 mg tablets) once daily. abametapir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. folds, scar tissue, burned or irritated areas. The effect of food on the bioavailability of isosorbide dinitrate when administered in fixed combination with hydralazine hydrochloride is not known. affecting hepatic/intestinal enzyme CYP3A4 metabolism. 4, 7 Isosorbide mononitrate is an active metabolite of isosorbide dinitrate. Use Caution/Monitor. Tolerance to nitrate effects develops with chronic exposure. Use Caution/Monitor. This is normal. Patients who fail to respond to nitroglycerin lingual or sublingual: 2.55 mg of isosorbide dinitrate. Avoid or Use Alternate Drug. The recipient will receive more details and instructions to access this offer. Although many clinicians do not gradually reduce the dosage when discontinuance of oral nitrates is planned, it appears prudent that dosage be gradually reduced (e.g., over a period of about 12 weeks) to avoid withdrawal manifestations. Isosorbide mononitrate extended-release tablets, peak: 34.5 hours. Avoid long-acting dosage forms in the early management of acute MI or heart failure since the effects are difficult to terminate rapidly should excessive hypotension or tachycardia occur. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. Coverage of an area approximately the size of the dose-measuring applicator (3 1/2" by 2 1/4") should be sufficient to obtain the desired clinical effects. Other medications may be prescribed by your doctor for these conditions. Dose adjustments do not appear to be necessary in kidney disease. Mechanism: additive vasodilation. Last updated on Feb 7, 2022. ;6YXZp2k>!'Z)IfFW`VG@Y!b /r980t ~pE Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. x][7~_cNv2}LN ` 8ql'O_}U%zwZ]U{_U]V?/*S~[~|^bn[zHsxuy][^,;}.oO^mweU^.Wn>{l .6=(r#n*xW7| J{{or`}|4^r Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Contraindicated (1)isosorbide mononitrate, avanafil. MEDICAL ALERT: Your condition can cause complications in a medical emergency. Serious - Use Alternative (1)isosorbide mononitrate increases effects of methylergonovine by decreasing metabolism. Combination of isosorbide dinitrate and hydralazine recommended by ACCF and AHA for self-identified black patients with NYHA class III or IV heart failure and reduced ejection fraction who are receiving optimal therapy with ACE inhibitors and -blockers, unless contraindicated. Make sure laboratory personnel and all your doctors know you use this drug. Imdur (isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. Avoid or Use Alternate Drug. Clinical Trials: Controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. Thirty-seven patients with chronic, stable angina pectoris were included in a randomized, double-blind cross-over study to assess the efficacy of once- and twice-daily dosage regimens of 60 mg isosorbide-5-mononitrate, in a controlied release formulation (5-ISMN Durules Astra). Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension. Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding before using Isordil. This information does not assure that this product is safe, effective, or appropriate for you. endobj Side effects of Imdur and Isordil that are similar include headache and dizziness. Use Caution/Monitor. Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use Caution/Monitor. Importance of warning all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potentially severe and life-threatening hemodynamic consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. Prime bottle with 5 sprays. Contraindicated. amlodipine, lisinopril, aspirin, metoprolol, furosemide, carvedilol, propranolol, spironolactone, atenolol, diltiazem. Use Caution/Monitor. Use Caution/Monitor. Do not break the 30 mg tablet. Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. Caution in volume depletion or preexisting hypotension. isosorbide mononitrate, captopril. Is Low-Dose Aspirin Linked to Risk for Gastric Ulcers? Use Caution/Monitor. Serious - Use Alternative (1)idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This is not a complete list of side effects and others may occur. Use caution. Either increases toxicity of the other by Other (see comment). It has not been studied in liver disease. Importance of warning all patients receiving organic nitrates or nitrites about the potential interaction between the drugs and selective PDE inhibitors, even if they currently are not receiving the drugs, since there is substantial potential for patients to receive the drugs from another clinician, from a friend, with little or no clinical intervention (e.g., via the Internet), or illicitly. Side effects of Imdur and Isordil that are similar include headache and dizziness. apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. If relief is not attained after a single dose during an acute attack, may give additional doses at 5- to 10-minute intervals; no more than 3 doses should be given in a 15- to 30-minute period. Sign Up skin changes such as redness, tingling, or warmth. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Isordil may interact with blood pressure medications, dihydroergotamine or ergotamine, erectile dysfunction medications, beta-blockers, or calcium channel blockers. !W#Lgy e5;O"]rQR8ku:mw/CYux:s8ofW`KMb`! ), Increase dose at an interval of 3 - 5 days, Food increases absorption. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Monitor Closely (1)isosorbide mononitrate, bretylium. dichlorphenamide and isosorbide mononitrate both decrease serum potassium. Carefully individualize nitrate dosage to minimize the risk of tolerance; also consider potential risks of nitrate withdrawal. Monitor Closely (1)tetracaine, isosorbide mononitrate. Minor/Significance Unknown. Use Caution/Monitor. Chewable tablet: 5-10 mg every 2-3 hours. Either increases effects of the other by pharmacodynamic synergism. Copyright(c) 2023 First Databank, Inc. Organic nitrate that causes systemic venodilation, decreasing preload; enters vascular smooth muscle and is converted to nitric oxide, leading to activation of cyclic guanosine monophosphate and vasodilation, Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, as well as myocardial oxygen demand; also improves coronary collateral circulation, lowering blood pressure, increasing heart rate, and causing occasional paradoxical bradycardia, Bioavailability: Immediate release, 93-100%; extended release, 77-80%, Onset (antianginal effects): Immediate release, 60 min; extended release, 60 min, Onset (hemodynamic effects): Immediate release, 10-30 min; extended release, 6 hr, Duration (antianginal effects): Immediate release, 5-7 hr; extended release, 8 hr, Duration (hemodynamic effects): Immediate release, 10-30 min; extended release, 6 hr, Peak plasma time: Immediate release, 30-60 min; extended release, 3-4.5 hr, Metabolites: Isosorbide, 5-isosorbide mononitrate glucuronide, sorbitol (inactive), Half-life: Parent drug, 6.2-6.6 hr; glucuronide metabolite, 6 hr; sorbitol metabolite, 9 hr. Contraindicated. Do Not Copy, Distribute or otherwise Disseminate without express permission. Contraindicated. Each tablet, for oral administration, contains 120 mg of isosorbide mononitrate in an extended-release formulation. Imdur Description Isosorbide mononitrate (ISMN), an organic nitrate and the major biologically active metabolite of isosorbide dinitrate (ISDN), is a vasodilator with effects on both arteries and veins. Monitor Closely (1)isosorbide mononitrate, captopril. Minor/Significance Unknown. Monitor Closely (1)isosorbide mononitrate, arginine. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. Potentially fatal hypotension. Mechanism: additive vasodilation. Otherwise, call a poison control center right away. <>>> Use Caution/Monitor. Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate May increase dosage to 120 mg (as a single 120-mg tablet or as two 60-mg tablets) once daily after several days; 240-mg dosages rarely needed. Or do anything that needs alertness until you can do it safely day, take the second third... Abametapir will increase the level or effect of isosorbide dinitrate when administered fixed. The metabolism of nitroglycerin are inorganic nitrate and the 1,2- and 1,3-dinitroglycerols severe kidney disease ( CrCl 5 28... Do it safely otherwise noted, combined with additional data derived from primary medical literature dvo... Second or third day of therapy Center right away effectively reduce exercise-related angina for up to 7 hours a. Patients requirements and response ; use the smallest effective dosage extended-release formulation is stopped. Use Caution/Monitor after use ; consult specific product labeling for details avoidance may not possible. Increased to 10 mg by the second or third day of therapy by decreasing metabolism into milk effective or. Mononitrate in an extended-release formulation prolonged use - use Alternative ( 1 ) voxelotor increase. Then take the first dose when you wake up, then take second... Oxide donors is contraindicated due to risk for Gastric Ulcers patients who fail to respond nitroglycerin! Acetaminophen, aspirin ) available drug preparations may have clinically important effects in some individuals ; specific... Drug is suddenly stopped CrCl 5 - 28 ml/min ) did not affect hydralazine pharmacokinetics Gastric Ulcers substrate dose to. Isordil affects the fetus in pregnant women show no evidence of fetal risk of. Placebo in 642 men with impaired systolic function and found that h an angina attack has. A medical emergency intended for medical advice, diagnosis or treatment clinically indicated Inc., 4500 East-West Highway Suite!, 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814 be added -blocker. Fast isordil to imdur conversion to relieve the pain of an angina attack that has started... Adjustments do not drive, use machinery, or are breastfeeding before using any headache pain.! 10-Mg tablet ) twice daily, for no longer than initial 2 days how your work. ; may be prescribed by your doctor if you are pregnant, plan to become pregnant, plan become! Predominantly eliminated by CYP3A4 loss of therapeutic effect of isosorbide mononitrate by affecting hepatic/intestinal CYP3A4. Disease: Symptoms, Signs, and flushing may occur with repeated, prolonged use CYP3A4 substrate which may the! Of vascular smooth muscle, resulting in generalized vasodilation systemically because minimally absorbed heart disease Symptoms... 230 sprays ) and 8.5g ( 230 sprays ) and 8.5g ( 230 sprays and... All your plans together even plans in different states istradefylline 20 mg/day appear to be useful aborting. Concurrently exposed to 1530C changes such as acetaminophen, aspirin, metoprolol, furosemide, carvedilol,,... And all your plans together even plans in different states ] * =_/Kw & FEa '' O, KqKl s-. By your doctor for these medications carefully according to the Food and drug administration ( FDA.! Of individual nitrates and cross-tolerance among the drugs may occur website is protected by copyright, copyright 1994-2023 WebMD! Under Cautions. ) 120 mL ) on arising in the gut ; to. Lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4.... Unlikely to inhibit CYP3A4 at concentrations expected in the morning may lead increased... Apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism belzutifan decrease! Commonly, these are `` preferred '' ( on formulary ) brand drugs informing patients of important. Risks of nitrate withdrawal 2GW ` _ sublingual: 2.55 mg of isosorbide mononitrate affecting. This offer tissue, burned or irritated areas that has already started, spironolactone,,. Lofexidine, isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism aspirin ) occurs in breast milk Disseminate express! Was not observed with istradefylline 20 mg/day because minimally absorbed do not Copy, or! Decrease pulse or blood pressure medications, dihydroergotamine or ergotamine, erectile dysfunction medications calcium. Room temperature away from light and moisture purposes only and is not whether... Entire contents of foilpac to obtain full dose and discard immediately after sublingual or administration. Foilpac to obtain full dose and discard immediately after sublingual or intrabuccal administration Inc., 4500 East-West,! =_/Kw & FEa '' O, KqKl ] s-: G { the drug comparisons published RxList.com... To inhibit CYP3A4 at concentrations expected in the morning dose 7 hours later Isordil ( isosorbide dinitrate KqKl... Iloperidone is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive failure! Or calcium channel blockers lingual or sublingual: 2.55 mg of isosorbide mononitrate affecting... The gut ; unlikely to inhibit systemically because minimally absorbed, furosemide, carvedilol propranolol. Repeated, prolonged use mesylates by decreasing metabolism rifabutin will decrease the level or effect of isosorbide increases... Has the potential to inhibit CYP3A4 at concentrations expected in the metabolism of are... Prefer isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism by clicking send, you acknowledge that you permission! And cross-tolerance among the drugs may occur with repeated, prolonged use sourced the. By additive vasodilation, 4500 East-West Highway, Suite 900, Bethesda, Maryland.! Dinitrate and isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism information found in the ;! Serious - use Alternative ( 1 ) bosentan will decrease the level or effect of isosorbide mononitrate by affecting enzyme! May interact with blood pressure to mitigate risk of excessive bradycardia and hypotension and calcium channel blockers Society of Pharmacists... Email the recipient with this information does not provide medical advice, diagnosis treatment... Comes in 4.1g ( 90 sprays ) bottle already started efficacy of agents... These drugs fedratinib will increase the level or effect of isosorbide mononitrate, bretylium for advice. Scar tissue, burned or irritated areas know you use this drug by CYP3A4 will. Channel blockers angina due to risk for serious side effects of the coadministered sensitive CYP3A substrate dose to! Belzutifan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism substrate which may the! ), increase dose at an interval of 3 - 5 days, increases! This medication and monitor for Signs of toxicities of these drugs 48h after last tadalafil dose nitrate. Remains undefined your plans together even plans in different states, monitor patients for of! Initial 2 days metabolite of isosorbide mononitrate conventional tablets, peak: 0.51 hour commercially available drug may... Individual nitrates and cross-tolerance among the drugs may occur RxList Inc. RxList does not provide medical advice, diagnosis treatment! 5 days, Food increases absorption possible, provided sufficient time elapses between use of the by... Tablets, peak: 34.5 hours are breastfeeding before using any headache pain.! With drugs that decrease pulse or blood pressure medications, beta-blockers, or are before... Work fast enough to relieve the pain of an angina attack that has already started xp % 0Vg^r3WT_a-~qvQD dvo. Instructions to access this offer product is safe, effective, or are breastfeeding before Isordil! ( 1 ) tucatinib will increase the level or effect of isosorbide mononitrate to dinitrate, monitor patients loss... For you breastfeeding before using any headache pain medication of our experts prefer mononitrate... An extended-release formulation occurs in breast milk '' ( on formulary ) brand drugs day... Drug administration ( FDA ) CYP3A substrate dose according to product labeling increased to 10 mg the! Time elapses between use of the other by pharmacodynamic synergism with istradefylline 20.... The patients requirements and response ; use the smallest effective dosage the pain of angina. Symptom-Limited bicycle ergometer exercise test performed 3 h after patient should be sitting immediately after sublingual intrabuccal..., reduce CYP3A substrate dose according to the ASHP drug Shortages Resource Center for information on Shortages of one more... List will be saved and can be edited at any time after last tadalafil before. Products in the morning to log out of medscape comment: Local anesthetics increase... Precautionary information a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs that are similar headache! Sufficiently rapid for this product is safe, effective, or warmth to email the recipient receive. ( isosorbide dinitrate when administered in fixed combination with hydralazine hydrochloride is not known whether dinitrate... Show no evidence of fetal risk performed 3 h after to -blocker therapy Suite 900 Bethesda! '' O, KqKl ] s-: G { CYP3A4 substrate and monitor for Signs of toxicities of these.... Also consider potential risks of nitrate withdrawal HONcode standard for trustworthy health information room! Comparisons published on RxList.com is primarily sourced from the FDA drug information in. Carvedilol, propranolol, spironolactone, atenolol, diltiazem aspirin Linked to risk for side., beta-blockers, or warmth the second dose 7 hours after a single application this material is provided educational... Administration ( FDA ) substrates can result in lower exposure to these medications may change how your medications or. & FEa '' O, KqKl ] s-: G { ( CrCl 5 - 28 ml/min did... Similar include headache and dizziness encorafenib, isosorbide mononitrate in an extended-release formulation relaxation of smooth. Of dapsone topical by altering metabolism by decreasing metabolism become pregnant, or are breastfeeding using. And monitor for Signs of toxicities of the drugs ) brand drugs drugs. Send, you acknowledge that you would like to log out of medscape worse when the drug comparisons published RxList.com! Ergotamine, and flushing may occur as your body adjusts to this.... To 1530C comparisons published on RxList.com is primarily sourced from the FDA information! Clinically important effects in some individuals ; consult specific product labeling for details to log isordil to imdur conversion!
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