Sublingual: 2.5-10 mg every 4-6 hours. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. 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 . Prices imdur to isordil dose conversion from levemir. . Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Isosorbide dinitrate sublingual, peak: 1015 minutes. Limit alcoholic beverages. Known hypersensitivity to isosorbide or any ingredient in the respective formulation. All Rights Reserved. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia. This document does not contain all possible drug interactions. Potentially fatal hypotension. prescription products. Extended-release oral nitrate preparations should not be used in patients with functional or organic GI hypermotility or malabsorption syndrome. Use Caution/Monitor. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. affecting hepatic/intestinal enzyme CYP3A4 metabolism. It is reasonable to believe that the rate and extent of nitroglycerin absorption from ointment may vary with the site and square measure of the skin over which a given dose of ointment is spread, but these relationships have not been adequately studied. Free Consultation! endobj Either increases effects of the other by pharmacodynamic synergism. commonly, these are generic drugs. To apply the ointment using one of the applicators, place the applicator on a flat surface, printed side down. To view formulary information first create a list of plans. Both direct vasodilatory effects on the coronary bed and drug-induced prevention of episodic coronary artery vasoconstriction increase total coronary blood flow. By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. Imdur (isosorbide mononitrate) Extended Release and Nitrolingual Pumpspray (nitroglycerin lingual spray) are vasodilators indicated for the prevention of angina pectoris. Nitrates in the management of acute coronary syndrome. Minor/Significance Unknown. Avoid or Use Alternate Drug. Readily absorbed from the GI tract; does not undergo first-pass hepatic metabolism. Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. Maximum: 80 mg 3 times/day. Monitor blood pressure. A: Generally acceptable. Rarely, 240 mg may be required. Possible hypotension. Manufacturers state that selective phosphodiesterase (PDE) inhibitors (e.g., sildenafil, tadalafil, vardenafil) are contraindicated in patients receiving nitrates. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. Contraindicated. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Use Caution/Monitor. 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. Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. USES: Isosorbide mononitrate is used to prevent chest pain (angina) in patients with a certain heart condition (coronary artery disease). isosorbide mononitrate, captopril. Contraindicated. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. Monitor Closely (1)dichlorphenamide and isosorbide mononitrate both decrease serum potassium. dabrafenib 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. 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 Importance of informing patients of other important precautionary information. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. Risk of increased SBP, angina pectoris. 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. An interdosing interval sufficient to avoid tolerance to Dilatrate-SR extended-release capsules is not known, but it must exceed 18 hours. Conventional tablets: Approximately 100%. isosorbide mononitrate, bretylium. Extended-release tablets: Approximately 7780%. (See Cautions.). Prolonged use of oral nitrates has been associated with the development of tolerance to the hemodynamic and antianginal effects and possibly with cross-tolerance to sublingual nitrates. Avoid long-acting dosage forms in the early management of acute MI or heart failure since the effects are difficult to terminate rapidly should excessive hypotension or tachycardia occur. Use Caution/Monitor. voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Elagolix is a weak-to-moderate CYP3A4 inducer. The target does is 20 mg twice daily. Ask your doctor before using any headache pain medication. It is not known if Isordil affects the fetus in pregnant women or if it occurs in breast milk. Mechanism: additive vasodilation. '~|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 Monitor Closely (1)isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism. As a result, any regimen of NITRO-BID administration should include a daily nitrate-free interval. 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. Monitor Closely (1)efavirenz will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Am J Cardiol 1993;72:871-6 4. Some conditions may become worse when the drug is suddenly stopped. Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. (See Tolerance and Dependence under Cautions.). Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Potentially fatal hypotension. <> This effect was not observed with istradefylline 20 mg/day. Dose escalation does not overcome this effect. Monitor Closely (1)ribociclib 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. It is important to take the drug at the same times each day. Adjust dosage of CYP3A4 substrates, if clinically indicated. IMDUR Tablets, for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide mononitrate in an extended-release formulation. Copyright 2021 GlobalRPH - Web Development by. Use Caution/Monitor. Potentially fatal hypotension. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. Isosorbide mononitrate: Generally, food delays the rate but not the extent of absorption (less than 10%) of conventional or extended-release tablets. Imdur may interact with sildenafil, other vasodilators, alcohol, calcium channel blockers, and organic nitrates. RxList does not provide medical advice, diagnosis or treatment. %H$Z7. This information does not assure that this product is safe, effective, or appropriate for you. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments. Most Do not rub into the skin. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. Either increases effects of the other by pharmacodynamic synergism. Serious - Use Alternative (1)fexinidazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. 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 . The drug information provided is intended for reference only and should not be used as a substitute for medical advice. Tecovirimat is a weak CYP3A4 inducer. Keep all medical and lab appointments. Monitor Closely (1)isosorbide mononitrate, captopril. 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. 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. % 4 0 obj Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Contraindicated. For oral dosage form (tablets): Adults20 milligrams (mg) two times a day. 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. Transient flushing may occur with the nitrates, and inhalation of amyl nitrite commonly causes cutaneous flushing of the head, neck, and clavicular area. MISSED DOSE: If you miss a dose, take it as soon as you remember. Canada residents can call a provincial poison control center. 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. Maximum daily dosage of Dilatrate-SR: 160 mg (4 capsules). Side effects of Imdur and Ranexa that are similar include headache and dizziness. May repeat in 5 minutes if needed. Peak effect: Sublingual tablet: 4-8 minutes; Translingual spray: 4-10 minutes; Buccal tablet: 4-10 minutes; Sustained release: 45-120 minutes; Topical: 30-120 minutes; Transdermal: 60-180 minutes; I.V. Consider increasing CYP3A substrate dose if needed. Mechanism: additive vasodilation. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Recent studies of other formulations of nitroglycerin suggest that the maximal achievable daily duration of anti-anginal effect from nitroglycerin ointment will be about 12 hours. It is an anti-anginal agent that works by relaxing the smooth muscles of both arteries and veins, but but predominantly veins to reduce cardiac preload. Contraindicated. Avoid or Use Alternate Drug. Serious - Use Alternative (1)ivosidenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Minor/Significance Unknown. [2,3], Hydralazine has not been studied extensively in kidney disease. Monitor Closely (1)nitroglycerin rectal, isosorbide mononitrate. 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. Modify Therapy/Monitor Closely. 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. Allow powder to dissolve without swallowing. Avoid or Use Alternate Drug. Access your plan list on any device mobile or desktop. Each tablet, for oral administration, contains 120 mg of isosorbide mononitrate in an extended-release formulation. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. % Coadministration may increase risk for adverse effects of CYP3A4 substrates. Importance of instructing patients receiving isosorbide dinitrate for relief of acute attacks of angina pectoris to consult a clinician or go to a hospital emergency room immediately if chest pain is not relieved after 3 doses approximately every 5 minutes, because inability to relieve chest pain may indicate acute MI. The maximal achievable daily duration of anti-anginal activity provided by nitroglycerin ointment therapy has not been studied. levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Adjust dose of drugs that are CYP3A4 substrates as necessary. 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. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Minor/Significance Unknown. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Modify Therapy/Monitor Closely. Use Caution/Monitor. Postural hypotension may occur and may cause dizziness, weakness, and other signs of cerebral ischemia. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. 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. May shower with patch on. 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. Monitor Closely (1)conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Either increases effects of the other by pharmacodynamic synergism. Imdur 60 mg od Imdur 120 mg od REFERENCES 1. After 2 weeks of treatment, during a symptom-limited bicycle ergometer exercise test performed 3 h after . 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. Consider dose reduction of sensitive CYP3A4 substrates. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed. Use Caution/Monitor. cenobamate will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. isosorbide mononitrate increases effects of methylergonovine by decreasing metabolism. 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. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate. Minoxidil can exacerbate fluid retention in kidney disease. 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 Serious - Use Alternative (1)abametapir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid extremities below the knee or elbow, skin May induce methemoglobinemia. mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism.

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