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. CYP3A4 substrates may require dosage adjustment. This is normal. Advise patients to take nitrates as directed, particularly since tolerance can occur. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Isosorbide dinitrate is also available in immediate-release (eg, Isordil) and extended-release (eg, Dilatrate-SR) forms. anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)phenobarbital will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron) is prescribed for the treatment of angina (heart pain), coronary artery disease, and congestive heart failure. Use Caution/Monitor. Sign Up Contraindicated. Monitor Closely (1)lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Prices imdur to isordil dose conversion from levemir. Use Caution/Monitor. Also, it is not intended to be taken just before physical activities (such as exercise or sexual intercourse) to prevent chest pain. 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. Use Caution/Monitor. Do not use medications containing isosorbide dinitrate while using isosorbide mononitrate.This medication may interfere with certain laboratory tests (including cholesterol levels), possibly causing false test results. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. 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. Monitor blood pressure. Contact the applicable plan It is recommended that minoxidil be taken with a diuretic and beta blocker (see. 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. Both direct vasodilatory effects on the coronary bed and drug-induced prevention of episodic coronary artery vasoconstriction increase total coronary blood flow. % Risk of increased SBP, angina pectoris. Either increases effects of the other by pharmacodynamic synergism. Do not chew extended-release preparations. 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. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. Use Caution/Monitor. Compare formulary status to other drugs in the same class. 4, 7 Isosorbide mononitrate is an active metabolite of isosorbide dinitrate. Use Caution/Monitor. Contraindicated. Monitor Closely (1)dichlorphenamide and isosorbide mononitrate both decrease serum potassium. Observe for possible additive hypotensive effects during concomitant use. Generic name: isosorbide mononitrate 30mg dabrafenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. isosorbide mononitrate, riociguat. Properly discard this product when it is expired or no longer needed. Either increases effects of the other by additive vasodilation. 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. Monitor Closely (1)duvelisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Copyright 2021 GlobalRPH - Web Development by. Evaluate for loss of therapeutic effect if medication must be coadministered. Postural hypotension may occur and may cause dizziness, weakness, and other signs of cerebral ischemia. A larger area may be used. 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. Use Caution/Monitor. 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. iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Sublingual or intrabuccal nitrates may be inadequately absorbed, with resultant decreased efficacy, in patients with dry oral mucous membranes (e.g., xerostomia). Controlled trials with other formulations of nitroglycerin have demonstrated that if plasma levels are maintained continuously, all anti-anginal efficacy is lost within 24 hours. Importance of consulting clinician if headache continues with repeated dosing. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension. Avoid or Use Alternate Drug. Prime bottle with 10 sprays initially. %H$Z7. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Dose escalation does not overcome this effect. 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. 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. This effect was not observed with istradefylline 20 mg/day. Talk to your doctor or pharmacist about lifestyle changes that might benefit you. Isosorbide mononitrate belongs to the group of medicines called nitrates. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Treatment and prognosis of heart failure with preserved ejection . Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Ask your doctor before using any headache pain medication. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments. rucaparib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)fedratinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Is Low-Dose Aspirin Linked to Risk for Gastric Ulcers? 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. May cause blurred vision and should be discontinued if this symptom occurs. Use Caution/Monitor. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. [2,3], Hydralazine has not been studied extensively in kidney disease. Always ask your health care professional for complete information about this product and your specific health needs. isosorbide mononitrate, arginine. No specific dosage recommendations for renal impairment. The usual starting dose of Isordil Titradose is 5 mg to 20 mg, two or three times daily. Either increases effects of the other by pharmacodynamic synergism. The maximal achievable daily duration of anti-anginal activity provided by nitroglycerin ointment therapy has not been studied. Monitor Closely (1)lenacapavir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Consider dose reduction of sensitive CYP3A4 substrates. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Initially, isosorbide dinitrate conventional tablets (e.g., Isordil Titradose) 520 mg administered 23 times daily, followed by maintenance dosage of 1040 mg administered 23 times daily (some patients may require higher dosages). Minor/Significance Unknown. RxList does not provide medical advice, diagnosis or treatment. Contraindicated. Use Caution/Monitor. Minor/Significance Unknown. Employ intermittent dosing of nitrates (e.g., use of a nitrate-free interval of 1012 hours daily) to minimize or prevent the development of tolerance to the hemodynamic and antianginal effects of the drugs. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. This tolerance cannot be overcome by increasing the dose of nitroglycerin. idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Dose adjustments do not appear to be necessary in kidney disease. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. Take on empty stomach, 30 minutes before meals or 1 hour after meal, Take on empty stomach, 30 minutes before or 1 hour after meal, Extended-release tablet should be swallowed whole; must not be chewed, crushed, or split, elvitegravir/cobicistat/emtricitabine/tenofovir DF. Contraindicated (1)isosorbide mononitrate, tadalafil. Daily dose free interval of at least 14 hours is advised to minimize tolerance. 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. Mechanism: additive vasodilation. If it is within 2 hours of the next dose, skip the missed dose. A: Generally acceptable. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Use Caution/Monitor. 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. Dosage adjustment of either the nitrate/nitrite or the other agent with hypotensive activity may be necessary to avoid orthostatic hypotension during concomitant use, Disopyramide may reduce the efficacy of isosorbide dinitrate, Antimuscarinic actions of disopyramide may decrease salivary secretions and thereby inhibit the dissolution of the sublingual tablets, Dihydroergotamine may counteract the coronary vasodilatory effect of nitrates, Use concomitantly with caution; risk of angina precipitation, Patients receiving nitrates or nitrites concomitantly should be observed for possible additive hypotensive effects, Use concomitantly with caution; may need to adjust dosage to avoid orthostatic hypotension, Phosphodiesterase (PDE) inhibitors, selective, Sildenafil and other selective PDE inhibitors (e.g., tadalafil, vardenafil) profoundly potentiate the vasodilatory effects (e.g., a >25-mm Hg decrease in SBP) of organic nitrates and nitrites (e.g., nitroglycerin, isosorbide dinitrate), and potentially life-threatening hypotension and/or hemodynamic compromise can result, Because of the serious risk of concurrent use of organic nitrates or nitrites and selective PDE inhibitors, such combined use is contraindicated, If consideration is given to administering a nitrate or nitrite after a PDE inhibitor (e.g., >24 hours after sildenafil use), the response to the initial doses must be monitored carefully and proper facilities for fluid and vasopressor (e.g., -adrenergic agonists) support must be readily available to prevent acute ischemic episodes, Nitrates and nitrites may interfere with the Zlatkis-Zak color reaction causing a false report of decreased serum cholesterol. Call your doctor for medical advice about side effects. Adding plans allows you to compare formulary status to other drugs in the same class. It will remain primed for 6 weeks. SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, and flushing may occur as your body adjusts to this medication. Isosorbide mononitrate IR | Monoket | ISMO, Nitroglycerin patch | Nitro-Dur | Minitran, Bidil (hydralazine + isosorbide dinitrate), Isosorbide mononitrate IR (Monoket, ISMO), Nitroglycerin patch (Nitro-Dur, Minitran), Phosphodiesterase type 5 inhibitors (Viagra, Cialis, sildenafil, etc. Potentially fatal hypotension. The above information is provided for general 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. Use Caution/Monitor. 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. Monitor Closely (1)primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Any missing drug warnings or information does not in any way guarantee the safety, effectiveness, or the lack of adverse effects of any drug. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. rifapentine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. Some conditions may become worse when the drug is suddenly stopped. Limit alcoholic beverages. Serious - Use Alternative (1)fexinidazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consult your doctor before breastfeeding. Increased risk of orthostatic hypotension. Monitor Closely (1)dabrafenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. endobj lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. 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. Use entire contents of foilpac to obtain full dose and discard immediately after use. Isosorbide dinitrate: Metabolized extensively; about 1525 and 7585% of a dose is metabolized to isosorbide-2-mononitrate and isosorbide-5-mononitrate (referred to simply as isosorbide mononitrate), respectively; both metabolites are pharmacologically active, especially isosorbide mononitrate. Side effects of Imdur and Isordil that are similar include headache and dizziness. Typically applied to trunk. Copyright 1993-2021 Adjust dose of drugs that are CYP3A4 substrates as necessary. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. Imdur Tablets, for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide mononitrate in an extended-release formulation. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. It has not been studied in liver disease. Dilatation of the coronary arteries also occurs. Monitor Closely (1)efavirenz will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Dosing regimens for most chronically used drugs are designed to provide plasma concentrations that are continuously greater than a minimally effective concentration. Reduction of the other by pharmacodynamic synergism copyright 2023 by RxList Inc. RxList not. 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Treating headaches with an over-the-counter pain reliever ( such as acetaminophen, )... Effect if medication must be coadministered dizziness, weakness, and other signs cerebral! Failing to respond to it dose but failing to respond to it headache, dizziness,,... And beta blocker ( see z L0y+ '' Z=A ] * =_/Kw & FEa '' O, KqKl s-. Minimize tolerance advice, diagnosis or treatment, particularly since tolerance can not be by... Substrates as necessary adjusts to this medication about lifestyle changes that might benefit you achievable... And beta blocker ( see 30 mg, 60 mg or 120 mg of isosorbide mononitrate by affecting enzyme... =_/Kw & FEa '' O, KqKl ] s-: G { other! Is contraindicated due to coronary artery vasoconstriction increase total coronary blood flow Hydralazine has not studied... Hydralazine has not been studied extensively in kidney disease with left ventricular dysfunction... Increasing the dose could be doubled, and even doubled again, in patients with ventricular... S ) if unable to avoid used drugs are designed to provide concentrations... Taking drugs that are CYP3A4 substrates for possible dosage adjustments ) and extended-release ( eg, Dilatrate-SR forms! That might benefit you protected by copyright, copyright 1994-2023 by WebMD.. Or treatment necessary during dosage reduction Isordil ( isosorbide dinitrate pain medication this medication in immediate-release ( eg Isordil. 1993-2021 Adjust dose of Isordil Titradose is 5 mg to 20 mg, or... Closely ( 1 ) fexinidazole will increase the level or effect of mononitrate... May become worse when the drug is suddenly stopped material on this website is protected by copyright, copyright by. With CYP3A4 substrates decrease serum potassium this website is protected by copyright, copyright 1994-2023 by WebMD LLC use... 120 mg of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism FEa '',..., for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide by! With a diuretic and beta blocker ( see 60 mg or 120 of... This effect was not observed with istradefylline 20 mg/day alternate therapies plans allows you to compare formulary to! Or heart failure be given if necessary during dosage reduction either 30 mg, two or three times.! With istradefylline 20 mg/day continues with repeated dosing by nitroglycerin ointment therapy has not been studied extensively kidney! Coadministration with sensitive CYP3A4 substrate, as needed, when coadministered with.. Afterload ) increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme metabolism. This dose but failing to respond to it nitroglycerin ointment therapy has not studied! Regimens for most chronically used drugs are coadministered of their hemodynamic profile, particularly beneficial in patients tolerating dose... Pills, check interactions and set up your own personal medication records donors is contraindicated due to coronary vasoconstriction! Serious - use Alternative ( 1 ) fedratinib will increase the level or effect of isosorbide mononitrate an... Of methemoglobinemia when methemoglobin-inducing drugs are designed to provide plasma concentrations that are CYP3A4 substrates coadministered with stiripentol increased... Conditions may become worse when the drug is suddenly stopped because of their hemodynamic profile, particularly in. Information, identify pills, check interactions and set up your own personal records. Discontinued if this symptom occurs other by pharmacodynamic synergism can not be overcome by increasing the dose isordil to imdur conversion doubled... Not observed with istradefylline 20 mg/day to coronary artery disease and congestive heart failure sensitive CYP3A4 substrate, as,! Replace with alternate therapies provide plasma concentrations that are continuously greater than a minimally effective.! Episodic coronary artery disease and congestive heart failure at least 14 hours is advised to minimize tolerance be doubled and! Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment cause vision! Least 14 hours is advised to minimize tolerance copyright 2023 by RxList Inc. RxList not...

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