Mechanism: additive vasodilation. 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. Use Caution/Monitor. Clinical Trials: Controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. Modify Therapy/Monitor Closely. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. CYP3A4 substrates may require dosage adjustment. Is Low-Dose Aspirin Linked to Risk for Gastric Ulcers? Either increases toxicity of the other by Other (see comment). Target: 40 mg 3 times/day. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Vasodilatory effect on arteriolar resistance is not as great as the action on the venous side; as a result of this combined action, both venous filling pressure (preload) and, to a lesser extent, arterial impedance (afterload) are reduced. Make sure laboratory personnel and all your doctors know you use this drug. Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding before using Isordil. Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. Adjust dose of drugs that are CYP3A4 substrates as necessary. Avoid or Use Alternate Drug. crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)rucaparib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Mechanism: additive vasodilation. Observe for possible additive hypotensive effects during concomitant use. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events. Any drug information published on RxList.com regarding general drug information, drug side effects, drug usage, dosage, and more are sourced from the original drug documentation found in its FDA drug monograph. Do not store in the bathroom. Warn all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potential 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. Imdur may interact with sildenafil, other vasodilators, alcohol, calcium channel blockers, and organic nitrates. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. Use Caution/Monitor. Consider increasing CYP3A substrate dose if needed. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. Adjust dose according to prescribing information if needed. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. STORAGE: Store at room temperature away from light and moisture. and formulary information changes. Either increases effects of the other by Mechanism: additive vasodilation. Advise patients of the likelihood of headache, particularly with initial nitrate therapy. Isosorbide dinitrate and isosorbide mononitrate are mainly excreted in the urine. 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. 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. amlodipine, lisinopril, aspirin, metoprolol, furosemide, carvedilol, propranolol, spironolactone, atenolol, diltiazem. Both Imdur and Isordil may interact with erectile dysfunction medications and calcium channel blockers. One manufacturer of isosorbide mononitrate states that dosage should be selected with caution, usually initiating therapy at the low end of the range, although age, renal, hepatic, and cardiovascular dysfunction do not appear to have a significant effect on drug clearance. Medscape Cardiologist Wealth & Debt Report 2021. Tape applicator in place. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension. Monitor Closely (1)nitroglycerin rectal, isosorbide mononitrate. Elagolix is a weak-to-moderate CYP3A4 inducer. elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Conversion table Original isosorbide prescription: Convert to: 10 mg twice a day at 8am and 4pm 20 mg twice a day at 8am and 4pm idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. AdultsAt first, 30 or 60 milligrams (mg) once a day. Do not break the 30 mg tablet. Use Caution/Monitor. Evaluate for loss of therapeutic effect if medication must be coadministered. <>stream Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate. Initially, (e.g., Imdur): 30 mg (as a single 30-mg tablet or as of a 60-mg tablet) or 60 mg (as a single 60-mg tablet) once daily. Either increases effects of the other by pharmacodynamic synergism. Headache, the most frequent adverse effect, may be severe (persistent or transient) and is perceived as a pulsating, throbbing sensation; frequent early in therapy, usually diminishes rapidly, and may disappear within several days to weeks of continuous therapy. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension. Comes in 4.1g (90 sprays) and 8.5g (230 sprays) bottle. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. May be re-primed with 2 sprays if not used within 6 weeks. N Eng J Med 1998;338:520-31 2. - Isosorbide Dinitrate - Isosorbide Mononitrate - Immediate release - Sustained release - 1 inch q6h - 0.4 mg/h - 15 mg tid - 10 mg bid - 30 mg/day REFERENCES 1. 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J{{or`}|4^r (See Selective Phosphodiesterase (PDE) Inhibitors under Cautions.). Use Caution/Monitor. Potentially fatal hypotension. You may report side effects to FDA at 1-800-FDA-1088. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. An interdosing interval sufficient to avoid tolerance to Dilatrate-SR extended-release capsules is not known, but it must exceed 18 hours. Modify Therapy/Monitor Closely. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. It is important to take the drug at the same times each day. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: drugs to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), riociguat, vericiguat.Some products have ingredients that could worsen your heart failure. Modify Therapy/Monitor Closely. Avoid or Use Alternate Drug. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. Tolerance to nitrate effects develops with chronic exposure. Monitor Closely (1)lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. drip: 3-5 minutes. Tolerance can only be overcome by short periods of nitrate absence from the body. Isosorbide dinitrate undergoes extensive first-pass metabolism in the liver and considerable extrahepatic metabolism. Rarely, 240 mg may be required. Use Caution/Monitor. Contraindicated. Contraindicated. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. %PDF-1.5
Potentially fatal hypotension. It does not work fast enough to relieve the pain of an angina attack that has already started. Risk of increased SBP, angina pectoris. Contraindicated. Brand names: Dilatrate, Imdur, Ismo, Isordil, Monoket 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. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. commonly, these are "non-preferred" brand drugs or specialty The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this medication, especially dizziness and lightheadedness, which could increase the risk of falls.During pregnancy, this medication should be used only when clearly needed. May titrate dosage to a maximum tolerated dosage not to exceed 2 tablets (a total of 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride) 3 times daily. Do not rub into the skin. Use Caution/Monitor. Monitor Closely (1)ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The effect of food on the bioavailability of isosorbide dinitrate when administered in fixed combination with hydralazine hydrochloride is not known. The level of glutathione S-transferases (GSH-ST) determined by following the reactions with of 1-chloro-2,4-dinitrobenzene (CDNB), o-dinitrobenzene (o-DNB) or . Prime bottle with 10 sprays initially. abametapir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2RydWcvaW1kdXItbW9ub2tldC1pc29zb3JiaWRlLW1vbm9uaXRyYXRlLTM0MjI3NQ==, View explanations for tiers and The dinitrates are less effective vasodilators than nitroglycerin, but they are longer-lived in the serum, and their net contribution to the overall effect of chronic nitroglycerin regimens is not known. encorafenib, isosorbide mononitrate. primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Isosorbide dinitrate: Food may decrease substantially mean peak plasma concentrations, yet total bioavailability does not seem to be affected. Pharmacokinetics: The volume of distribution of nitroglycerin is about 3 L/kg, and nitroglycerin is cleared from this volume at extremely rapid rates, with a resulting serum half-life of about three minutes. Both drugs lower blood pressure. Use Caution/Monitor. elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minoxidil can exacerbate fluid retention in kidney disease. Z
L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. Dose adjustments do not appear to be necessary in kidney disease. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. No more than 3 doses in a 15- to 30-minute period. nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Supplied: Regular release tablets: 10 mg, 20 mg. Extended release tablets: 30 mg, 60 mg, 120 mg. CLINICAL PHARMACOLOGY The principal pharmacological action of nitroglycerin is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins, especially the latter. Dosage form: tablet, extended release Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. The drug information provided is intended for reference only and should not be used as a substitute for medical advice. Avoid or Use Alternate Drug. 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. Prime bottle with 5 sprays. Minor/Significance Unknown. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. Particularly small stature, maintenance: Increased to at least 10 mg twice daily by the second or third day. Suggested schedules: Usually, at 7 a.m., 12 p.m., and 5 p.m. in chronic stable angina or at 7 a.m. and 12 p.m. in less severely symptomatic angina in order to allow for a nitrate-free interval of 1014 hours. Isosorbide dinitrate fixed-combination tablets with hydralazine hydrochloride, peak: 60 minutes. Modify Therapy/Monitor Closely. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. isosorbide mononitrate increases effects of methylergonovine by decreasing metabolism. Avoid or Use Alternate Drug. It is unknown if Imdur passes into breast milk. Monitor Closely (1)crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Side effects of Imdur and Isordil that are similar include headache and dizziness. Monitor Closely (1)isosorbide mononitrate, captopril. Talk to your doctor or pharmacist about lifestyle changes that might benefit you. Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and not smoking may help this drug work better. Monitor blood pressure. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Benefits in acute MI and heart failure not established. Also, it is not intended to be taken just before physical activities (such as exercise or sexual intercourse) to prevent chest pain. It has not been studied in liver disease. In chronic dosing, duration of effect is much shorter due to tolerance, Patients with chest pain should take 1 dose of quick-acting
nitroglycerin, If pain is not improved or worsening after 5 minutes, it is recommended
that 9-1-1 be called, and further instructions should be taken from them, If pain is significantly improved after 1 dose, then 2 more doses should
be given five minutes apart (total of 3 doses), and 9-1-1 should be called
if pain does not resolve completely [4], Nitrates should not be taken within 24 hours of sildenafil (Viagra), Nitrates should not be taken within 48 hours of tadalafil (Cialis), The suitable time for the administration of nitrates after vardenafil (Levitra) has not been determined [11], Nitroglycerin is metabolized by a reductase enzyme in the liver, Nitroglycerin also undergoes extrahepatic metabolism in red blood cells and vascular walls, Pricing based on one month of therapy at standard dosing in an adult, Pricing based on information from GoodRX.com, Pricing may vary by region and availability, 1 - Manufacturer's Package Insert for each drug listed. The drug comparison information found in this article does not contain any data from clinical trials with human participants or animals performed by any of the drug manufacturers comparing the drugs. CYP3A4 substrates may require dosage adjustment. encoded search term (isosorbide mononitrate (Imdur%2C Monoket)) and isosorbide mononitrate (Imdur, Monoket), ECG Challenge: Lightheadedness and Extremely Slow Pulse. Dose escalation does not overcome this effect. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). Consult your doctor before breast-feeding. Contraindicated (1)isosorbide mononitrate, sildenafil. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. 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. Use Caution/Monitor. Use Caution/Monitor. Please confirm that you would like to log out of Medscape. Caution in volume depletion or preexisting hypotension. Do not stop taking it without consulting your doctor. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. May cause blurred vision and should be discontinued if this symptom occurs. Use Caution/Monitor. Contraindicated. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. Adding plans allows you to compare formulary status to other drugs in the same class. Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. Isosorbide mononitrate (ismo , monoket ), Isosorbide mononitrate (Ismo , Monoket ), HONcode standard for trust- worthy health, Pediatric Oncology: Diagnosis And Prognosis Communication, Works by relaxation of smooth muscle, producing a vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins. Most Modify Therapy/Monitor Closely. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension. The above information is provided for general Evaluate for loss of therapeutic effect if medication must be coadministered. If unavoidable, reduce CYP3A substrate dose according to product labeling. 1 0 obj
Serious - Use Alternative (1)idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Squeeze the necessary amount of ointment from the tube onto the applicator, place the applicator (ointment side down) on the desired area of the skin, and tape the applicator into place. stream
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. provider for the most current information. Below is a conversion table to enable using this preparation in place of standard release isosorbide mononitrate and modified release (M/R) preparations which are not going to be kept. Coadministration may increase risk for adverse effects of CYP3A4 substrates. Current guidelines recommend a combination of drug therapies (e.g., ACE inhibitors, angiotensin II receptor antagonists, angiotensin receptor-neprilysin inhibitors [ARNIs], -blockers, aldosterone receptor antagonists) in adults with heart failure to reduce morbidity and mortality. We comply with the HONcode standard for trustworthy health information. Avoid or Use Alternate Drug. Administer extended-release tablets with adequate amounts of fluid (e.g., 120 mL) on arising in the morning. Use Caution/Monitor. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. A starting dose of 5 mg twice a day may be appropriate in smaller patients. Serious - Use Alternative (1)isosorbide mononitrate increases effects of ergoloid mesylates by decreasing metabolism. Isosorbide mononitrate - Some of our experts prefer isosorbide mononitrate to dinitrate. Serious - Use Alternative (1)carbamazepine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide dinitrate and isosorbide mononitrate are mainly excreted in the urine. Drugs 1995;49:196-9 3. Monitor Closely (1)primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.
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