Monitor Closely (1)maraviroc, isosorbide mononitrate. % 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. Nitrates in the management of acute coronary syndrome. Risk of increased SBP, angina pectoris. The two doses should be administered 7 hours apart in order to avoid tolerance (decreased effect after several doses). 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. MISSED DOSE: If you miss a dose, take it as soon as you remember. AdultsAt first, 30 or 60 milligrams (mg) once a day. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed. PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as isosorbide dinitrate, nitroglycerin); or if you have any other allergies. 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. Minor/Significance Unknown. Avoid or Use Alternate Drug. 4, 7 Isosorbide mononitrate is an active metabolite of isosorbide dinitrate. Use Caution/Monitor. Risk of increased SBP, angina pectoris. Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding before using Isordil. It has not been studied in liver disease. Modify Therapy/Monitor Closely. ivosidenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)stiripentol, isosorbide mononitrate. Minor/Significance Unknown. Conventional tablets: Approximately 100%. . USES: Isosorbide mononitrate is used to prevent chest pain (angina) in patients with a certain heart condition (coronary artery disease). Talk to your doctor or pharmacist about lifestyle changes that might benefit you. 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). IMDUR Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. Consult your pharmacist or local waste disposal company. Contraindicated. Contraindicated. This strategy is inappropriate for organic nitrates. Symptoms of overdose may include: slow heartbeat, vision changes, severe nausea/vomiting, sweating, cold/clammy skin, bluish fingers/toes/lips. Copyright 2023, Selected Revisions February 7, 2017. In the large majority of these trials, active agents were indistinguishable from placebo after 24 hours (or less) of continuous therapy. Due to the time-sensitive nature of drug information, RxList.com makes no guarantees that the information provided is the most current. Do not break the 30 mg tablet. 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. Use Caution/Monitor. Evaluate for loss of therapeutic effect if medication must be coadministered. Modify Therapy/Monitor Closely. It is important to take the drug at the same times each day. The dinitrates are further metabolized to (non-vasoactive) mononitrates and, ultimately, to glycerol and carbon dioxide. May be re-primed with 2 sprays if not used within 6 weeks. 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. Use Caution/Monitor. Conventional oral tablets: 25% unchanged drug; about half that following sublingual administration (4050%). Either increases effects of the other by additive vasodilation. Minor/Significance Unknown. Minor/Significance Unknown. Use Caution/Monitor. Potentially fatal hypotension. Potentially fatal hypotension. Monitor Closely (1)belzutifan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. Monitor Closely (1)conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. It works by relaxing the . Coadministration may increase risk for adverse effects of CYP3A4 substrates. May induce methemoglobinemia. The manufacturer of the fixed combination of isosorbide dinitrate and hydralazine hydrochloride states that dosage should be selected with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. We comply with the HONcode standard for trustworthy health information. Isosorbide dinitrate conventional tablets, peak: 60 minutes. Use Caution/Monitor. 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. . 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. % Less frequent administration of isosorbide dinitrate may reduce the development of tolerance to the drugs antianginal effects. Heart Disease: Symptoms, Signs, and Causes. Adjust dose according to prescribing information if needed. Either increases effects of the other by pharmacodynamic synergism. Mechanism: additive vasodilation. The first products in the metabolism of nitroglycerin are inorganic nitrate and the 1,2- and 1,3-dinitroglycerols. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Use Caution/Monitor. Monitor Closely (1)efavirenz will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. informational and educational purposes only. Avoid or Use Alternate Drug. Use Caution/Monitor. 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. 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 Safety and effectiveness of Isordil in pediatric patients have not been established. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Copyright 1993-2021 Use Caution/Monitor. 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. mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. For maintenance therapy, 10 mg to 40 mg, two or three times daily, is recommended. 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. Chewable tablet: 5-10 mg every 2-3 hours. Avoid or Use Alternate Drug. Contraindicated (1)isosorbide mononitrate, avanafil. . This is normal. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. 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. Serious - Use Alternative (1)idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. 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. CYP3A4 substrates may require dosage adjustment. Stiripentol is a CYP3A4 inhibitor and inducer. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Minor/Significance Unknown. levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. Modify Therapy/Monitor Closely. acetazolamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Observe for possible additive hypotensive effects during concomitant use. This information does not assure that this product is safe, effective, or appropriate for you. isosorbide mononitrate, riociguat. 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. Mechanism: additive vasodilation. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Do not chew extended-release preparations. 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. istradefylline 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. <>>> Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. Imdur (isosorbide mononitrate) Extended Release and Ranexa (ranolazine) are indicated for the prevention of angina pectoris. Your doctor may increase your dose as needed. 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