Select one or more newsletters to continue. Half-life. Serious - Use Alternative (1)apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Adjust dosage of CYP3A4 substrates, if clinically indicated. This website also contains material copyrighted by 3rd parties. Either increases effects of the other by pharmacodynamic synergism. Monitor Closely (1)dabrafenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. %H$Z7. Serious - Use Alternative (1)ivosidenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The dose can be increased to 10 mg twice daily after 2 to 3 days. Readily (and almost completely) absorbed from the GI tract and oral mucosa, but considerable variations in the bioavailability (1090%) secondary to extensive first-pass metabolism in the liver. Risk of increased SBP, angina pectoris. Adjust dose according to prescribing information if needed. Severe hypotension, particularly in upright position, can occur even with low doses. Monitor Closely (1)tetracaine, isosorbide mononitrate. Modify Therapy/Monitor Closely. Tight, light-resistant containers at room temperature (25C); do not expose to extremes in temperature. Modify Therapy/Monitor Closely. isosorbide mononitrate, vardenafil. The exact mechanism of action in the relief of angina pectoris has not been fully elucidated. "[~ Fexinidazole inhibits CYP3A4. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. commonly, these are "non-preferred" brand drugs or specialty Administer extended-release tablets with adequate amounts of fluid (e.g., 120 mL) on arising in the morning. encoded search term (isosorbide mononitrate (Imdur%2C Monoket)) and isosorbide mononitrate (Imdur, Monoket), ECG Challenge: Lightheadedness and Extremely Slow Pulse. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events. The drug comparisons information provided does not cover every potential use, warning, drug interaction, side effect, or adverse or allergic reaction. Is Low-Dose Aspirin Linked to Risk for Gastric Ulcers? 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. Avoid or Use Alternate Drug. Start with lower doses and titrate slowly. isosorbide mononitrate, sildenafil. Modify Therapy/Monitor Closely. It is recommended that minoxidil be taken with a diuretic and beta blocker (see minoxidil side effects) May take without regard to food Hair loss (off-label) Dosing: 0.25 - 5 mg once daily See low-dose oral minoxidil for hair loss May take without regard to food Kidney disease Minoxidil can exacerbate fluid retention in kidney disease. ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The dinitrates are further metabolized to (non-vasoactive) mononitrates and, ultimately, to glycerol and carbon dioxide. Avoid or Use Alternate Drug. The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. Monitor Closely (1)bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. fedratinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Subsequent studies discovered that a chemical reaction between . Growing cells of Tetrahymena thermophila (T. t.) metabolized, after 72 h, 80% of isosorbide dinitrate (ISDN) to isosorbide 5-mononitrate (5-ISMN) and isosorbide 2-mononitrate (2-ISMN) in a ratio 5-ISMN/2-ISMN=2.6 as evaluated by HPLC. In some controlled trials of other organic nitrate formulations, efficacy has declined with time. This site complies with the HONcode standard for trust- worthy health information: verify here. Use Caution/Monitor. Monitor Closely (1)duvelisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Please confirm that you would like to log out of Medscape. Avoid or Use Alternate Drug. Treatment and prognosis of heart failure with preserved ejection . Either increases effects of the other by pharmacodynamic synergism. Your doctor may increase your dose as needed. This drug is available at a higher level co-pay. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).Isosorbide mononitrate is very similar to isosorbide dinitrate. Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use. Otherwise, call a poison control center right away. Avoid or Use Alternate Drug. 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). Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. 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. Nitroglycerin undergoes metabolism in the liver and at sites outside of the liver. Modify Therapy/Monitor Closely. 1 - 2 sprays on or under the tongue at the onset of pain. Monitor Closely (1)isosorbide mononitrate, arginine. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Chewable tablet: 5-10 mg every 2-3 hours. Careful clinical or hemodynamic monitoring for possible hypotension or tachycardia if used in acute MI or heart failure. Either increases effects of the other by additive vasodilation. Side effects of Isordil that are different from Imdur include weakness and skin changes such as redness, tingling, or warmth. 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. If headaches continue or become severe, tell your doctor promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. May repeat in 5 minutes if needed. Contraindicated. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension. Either increases toxicity of the other by Other (see comment). Risk of elevated blood concentrations of isosorbide dinitrate in patients with cirrhosis. Prime bottle with 10 sprays initially. The daily dose of IMDUR Tablets should be taken in the morning on arising. Tape applicator in place. Conventional oral tablets: 25% unchanged drug; about half that following sublingual administration (4050%). Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Isordil may interact with blood pressure medications, dihydroergotamine or ergotamine, erectile dysfunction medications, beta-blockers, or calcium channel blockers. Either increases effects of the other by pharmacodynamic synergism. tetracaine, isosorbide mononitrate. Monitor Closely (1)conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Rapid titration (over 35 days) may be possible; however, slower titration may be needed due to adverse effects. No more than 3 doses in a 15- to 30-minute period. Last updated on Feb 7, 2022. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. Importance of consulting clinician if headache continues with repeated dosing. Do not break the 30 mg tablet. Advise patients of the likelihood of headache, particularly with initial nitrate therapy. Imdur (isosorbide mononitrate) Extended Release Tablets are a vasodilator indicated for the prevention of angina pectoris due to coronary artery disease. Contraindicated (1)isosorbide mononitrate, sildenafil. 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. (See Geriatric Patients under Dosage.). May shower with patch on. Modify Therapy/Monitor Closely. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed. Monitor Closely (1)elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Warn 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. Observe for possible additive hypotensive effects during concomitant use. dichlorphenamide and isosorbide mononitrate both decrease serum potassium. Caution if used in nursing women. Modify Therapy/Monitor Closely. Supplied: Capsule, sustained release (Dilatrate-SR): 40 mg Tablet: 5 mg, 10 mg, 20 mg, 30 mg, 40mg Tablet, extended release (Isochron): 40 mg Sublingual tablet: 2.5 mg, 5 mg. David McAuley, Pharm.D. Available for Android and iOS devices. Contact the applicable plan tazemetostat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. In addition to vascular smooth muscle, nitrates and nitrites relax bronchial, biliary (including the gallbladder, biliary ducts, and sphincter of Oddi), GI (including the esophagus), ureteral, and uterine smooth muscle; nitrates relax all smooth muscle irrespective of autonomic innervation and are functional antagonists of norepinephrine, acetylcholine, and histamine. 1 0 obj Isosorbide dinitrate (Isordil) is good for a specific type of chest pain (called angina), but it can cause headaches after you take it. IMDUR Tablets, for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide mononitrate in an extended-release formulation. Evaluate for loss of therapeutic effect if medication must be coadministered. Use Caution/Monitor. The patient should be sitting immediately after sublingual or intrabuccal administration. Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. Use Caution/Monitor. Contraindicated. 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. Avoid or Use Alternate Drug. Use Caution/Monitor. All drug information provided on RxList.com is sourced directly from drug monographs published by the U.S. Food and Drug Administration (FDA). VA class: CV250 Dilatation of the coronary arteries also occurs. elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. IMDUR Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. Modify Therapy/Monitor Closely. Compare formulary status to other drugs in the same class. Minor/Significance Unknown. Avoid or Use Alternate Drug. Isosorbide mononitrate - Some of our experts prefer isosorbide mononitrate to dinitrate. Other (see comment). Typically applied to trunk. fexinidazole will increase 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. Contraindicated. Both direct vasodilatory effects on the coronary bed and drug-induced prevention of episodic coronary artery vasoconstriction increase total coronary blood flow. CYP3A4 substrates may require dosage adjustment. Avoid or Use Alternate Drug. Isosorbide dinitrate sublingual, peak: 1015 minutes. Administer sublingually, intrabuccally, or orally. conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Do not store in the bathroom. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Conventional tablets: Approximately 100%. Molecular formula: C6H8N2O8C6H9NO6 All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Use Caution/Monitor. Isosorbide mononitrate: Approximately 45%. Extended-release tablets: Approximately 7780%. Isosorbide dinitrate: Food may decrease substantially mean peak plasma concentrations, yet total bioavailability does not seem to be affected. Take consistently either with or without food. Medscape Education. Minor (1)anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Also, it is not intended to be taken just before physical activities (such as exercise or sexual intercourse) to prevent chest pain. Tight, light-resistant containers at 25C; may be exposed to 1530C. <>stream Safety and effectiveness of Isordil in pediatric patients have not been established. Use Caution/Monitor. The first products in the metabolism of nitroglycerin are inorganic nitrate and the 1,2- and 1,3-dinitroglycerols. idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. This is not a complete list of side effects and others may occur. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor blood pressure. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. acetylcysteine (Antidote) increases effects of isosorbide mononitrate by Other (see comment). Drugs 1995;49:196-9 3. ChildrenUse and dose must be determined by your doctor. ACCF and AHA recommend initial dosage of 2030 mg 3 or 4 times daily; give concomitantly with hydralazine hydrochloride 2550 mg 3 or 4 times daily. Imdur may interact with sildenafil, other vasodilators, alcohol, calcium channel blockers, and organic nitrates. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. Tolerance can only be overcome by short periods of nitrate absence from the body. Minor/Significance Unknown. A starting dose of 5 mg twice a day may be appropriate in smaller patients. Indications Angina (a specific type of chest pain) caused by heart disease Chest pain caused by angina Pros and Cons Pros Good at preventing chest pain caused by heart disease If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. It works by relaxing the . Use Caution/Monitor. In one small study (N=49), severe kidney disease (CrCl 5 - 28 ml/min) did not affect hydralazine pharmacokinetics. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. Avoid or Use Alternate Drug. The recommended starting dose of isosorbide mononitrate is 5 to 10 mg of immediate release tablets twice daily. Consult your doctor for more details. The Vasodilator-Heart Failure Trials I and II. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. efavirenz will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Canada residents can call a provincial poison control center. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia. Importance of informing patients receiving isosorbide dinitrate in fixed combination with hydralazine that inadequate fluid intake or excessive fluid loss due to diarrhea, vomiting, or perspiration may result in excessive hypotension, possibly leading to lightheadedness or syncope; if syncope occurs, discontinue treatment and notify clinician immediately. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Take your next dose at the regular time. 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. 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. rucaparib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consult your pharmacist or local waste disposal company. acetazolamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Do not chew extended-release preparations. After removing patch, skin may feel warm and appear red. istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Extended-release oral nitrate preparations should not be used in patients with functional or organic GI hypermotility or malabsorption syndrome. Imdur ER; Ismo; Monoket; Descriptions. CYP3A4 substrates may require dosage adjustment. Mechanism: additive vasodilation. Minor/Significance Unknown. Avoid or Use Alternate Drug. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. May need to adjust schedule for those arising earlier than 7 a.m. since early morning angina is common. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. isosorbide mononitrate, riociguat. Monitor Closely (1)iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Aspirin or acetaminophen may relieve. Consider increasing CYP3A substrate dose if needed. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Headache is often a sign that this medication is working. Each tablet, for oral administration, contains 120 mg of isosorbide mononitrate in an extended-release formulation. Use Caution/Monitor. Manage and view all your plans together even plans in different states. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. 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. Eccentric dosing with isosorbide-5-mononitrate in angina pectoris. Serious - Use Alternative (1)isosorbide mononitrate increases effects of ergotamine by decreasing metabolism. Use Caution/Monitor. For maintenance therapy, 10 mg to 40 mg, two or three times daily, is recommended. Tell your doctor all medications and supplements you use. fosphenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. 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). - 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. Do not rub into the skin. Isosorbide dinitrate: About 1 hour. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.