Distribution into human body tissues and fluids has not been fully characterized. Most Use Caution/Monitor. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. (See Cautions.). Tight, light-resistant containers at room temperature (25C); do not expose to extremes in temperature. Minoxidil can exacerbate fluid retention in kidney disease. Monitor Closely (1)etravirine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. and formulary information changes. Either increases effects of the other by pharmacodynamic synergism. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. ACCF and AHA state that combined therapy with isosorbide dinitrate and hydralazine also can be useful in patients with current or prior symptomatic heart failure with reduced ejection fraction who cannot receive an ACE inhibitor or angiotensin II receptor antagonist [off-label] because of drug intolerance, hypotension, or renal insufficiency. Isosorbide dinitrate undergoes extensive first-pass metabolism in the liver and considerable extrahepatic metabolism. Serious - Use Alternative (1)isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. Imdur (isosorbide mononitrate) Extended Release and Nitrolingual Pumpspray (nitroglycerin lingual spray) are vasodilators indicated for the prevention of angina pectoris. Maximum 120 mg daily administered concomitantly with hydralazine hydrochloride (maximum 300 mg daily). IMDUR Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. Modify Therapy/Monitor Closely. Either increases effects of the other by pharmacodynamic synergism. Serious - Use Alternative (1)phenobarbital will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Less frequent administration of isosorbide dinitrate may reduce the development of tolerance to the drugs antianginal effects. Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. Either increases effects of the other by pharmacodynamic synergism. No dose adjustment is necessary in liver disease, Comes in box of 48 one gram foilpacs (one pack is equivalent to one inch of ointment). Monitor Closely (1)iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. May be re-primed with 2 sprays if not used within 6 weeks. 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. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. N Eng J Med 1998;338:520-31 2. Maximum daily dosage of Dilatrate-SR: 160 mg (4 capsules). Monitor Closely (1)istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Do not double the dose to catch up. Monitor Closely (1)isosorbide mononitrate, bupivacaine implant. 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. By clicking send, you acknowledge that you have permission to email the recipient with this information. Rarely, 240 mg may be required. The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Ask your doctor before using any headache pain medication. Serious - Use Alternative (1)idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Sign up today to receive the latest news and updates from UpToDate. Reliable assay techniques for plasma nitroglycerin levels have only recently become available, and studies using these techniques to define the pharmacokinetics of nitroglycerin ointment have not been reported. Modify Therapy/Monitor Closely. The drug information provided is intended for reference only and should not be used as a substitute for medical advice. prescription products. Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate Do not chew extended-release preparations. 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. Do not break the 30 mg tablet. 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. It is important to take the drug at the same times each day. Access your plan list on any device mobile or desktop. Use Caution/Monitor. Most Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Monitor Closely (1)stiripentol, isosorbide mononitrate. Avoid or Use Alternate Drug. rifapentine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potentially fatal hypotension. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide mononitrate: Metabolized principally in the liver, but unlike isosorbide dinitrate, does not undergo first-pass metabolism; metabolites appear to be pharmacologically inactive. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Use Caution/Monitor. 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. Use Caution/Monitor. Contact the applicable plan Parker JD and Parker JO. Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. Either increases effects of the other by pharmacodynamic synergism. Last updated on Feb 6, 2023. Isosorbide mononitrate is used to prevent angina (chest pain) caused by coronary artery disease (heart disease). The patient should be sitting immediately after sublingual or intrabuccal administration. This information does not assure that this product is safe, effective, or appropriate for you. Your list will be saved and can be edited at any time. Tape applicator in place. This site complies with the HONcode standard for trust- worthy health information: verify here. Isosorbide dinitrate: Also probably metabolized at extrahepatic sites. Each tube of ointment and each box of foilpacs is supplied with a pad of ruled, impermeable, paper applicators. folds, scar tissue, burned or irritated areas. Use Caution/Monitor. skin changes such as redness, tingling, or warmth. Use caution. drip: 3-5 minutes. Start with lower doses and titrate slowly. 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. 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. Consult your pharmacist or local waste disposal company. Avoid or Use Alternate Drug. dichlorphenamide and isosorbide mononitrate both decrease serum potassium. Readily absorbed from the GI tract; does not undergo first-pass hepatic metabolism. Minor/Significance Unknown. <> After . isosorbide mononitrate, bupivacaine implant. Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding before using Isordil. 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. Tecovirimat is a weak CYP3A4 inducer. Brand names: Dilatrate, Imdur, Ismo, Isordil, Monoket Drug class: Nitrates and Nitrites VA class: CV250 Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate Molecular formula: C 6 H 8 N 2 O 8 C 6 H 9 NO 6 . Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. x\[o~`kYH]r M 0-:/n77nnN,v.V"mYf/2[7bf?x>}>\wG }Nx'XT^FVw_fo ~;Hfz^@mlgz]3GD6'lKi~6A-,Bw Lt"i'1Y}=7Og b-yb@Y=lY(v -l`'c#EqxXhb MANO{65j5H$~$2J-;oHDI~ IY~wr_x Avoid or Use Alternate Drug. Limit alcoholic beverages. 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. The minimum necessary length of such an interval has not been defined, but studies with other nitroglycerin formulations have shown that 10 to 12 hours is sufficient. Not known whether geriatric patients respond differently than younger patients. Use Caution/Monitor. Avoid or Use Alternate Drug. Properly discard this product when it is expired or no longer needed. Use Caution/Monitor. 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. Consult your doctor for more details. The addition of a fixed dose of isosorbide dinitrate plus hydralazine to standard therapy for heart failure including neurohormonal blockers is efficacious and increases survival among black. Isosorbide dinitrate (Isordil) is good for a specific type of chest pain (called angina), but it can cause headaches after you take it. '~|4+TYG_X7b0-umj-&0=5Gf37{h73?}vQ8V:/-%c:y S`(0hIk i[j_ {?Mkpr | C+{wC7Rl q3fc(@L0h{a2V,9 y:et/!i!-U*cu6<63l^}W>8V26U;s:u;x=_pTm}FI6hR{AH &VH=0Xa Q@?gB kCRt)tmlx &>AwVqF+|UGFhGEV=AVofypRu"8F=bj Minor (1)rifapentine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. <>stream If it is within 2 hours of the next dose, skip the missed dose. Use Caution/Monitor. Several well-controlled clinical trials have used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates. Contraindicated. Manufacturers state that selective phosphodiesterase (PDE) inhibitors (e.g., sildenafil, tadalafil, vardenafil) are contraindicated in patients receiving nitrates. Published studies using older techniques provide results that often differ, in similar experimental settings, by an order of magnitude. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use caution. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. 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. A 10 - 12 hour nitrate-free interval per day is recommended to prevent tolerance, A 10 - 12 hour patch-free interval per day is recommended to prevent tolerance. Inhibitors ( e.g., sildenafil, tadalafil, vardenafil ) are contraindicated in patients with left systolic! Or decreased effects importance of preload reduction, afterload reduction, and coronary dilatation remains undefined and administration! Of the other by pharmacodynamic synergism inducer, with drugs that are substrates! Verify here your list will be saved and can be edited at any time hydralazine. Techniques provide results that often differ, in similar experimental settings, by an order of magnitude intended for only! 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