Avoid or Use Alternate Drug. Serious - Use Alternative (1)isosorbide mononitrate increases effects of ergoloid mesylates by decreasing metabolism. 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). Heart Disease: Symptoms, Signs, and Causes. Use Caution/Monitor. Parker JD. 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. STORAGE: Store at room temperature away from light and moisture. Contraindicated (1)isosorbide mononitrate, riociguat. Either increases effects of the other by pharmacodynamic synergism. Each tablet, for oral administration, contains 120 mg of isosorbide mononitrate in an extended-release formulation. Use Caution/Monitor. Dosage form: tablet, extended release Supplied: Regular release tablets: 10 mg, 20 mg. Extended release tablets: 30 mg, 60 mg, 120 mg. CLINICAL PHARMACOLOGY The principal pharmacological action of nitroglycerin is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins, especially the latter. isosorbide mononitrate, riociguat. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Observe for possible additive hypotensive effects during concomitant use. 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. Adding plans allows you to compare formulary status to other drugs in the same class. elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This is normal. Monitor Closely (1)ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Imdur (isosorbide mononitrate) Extended Release and Nitrolingual Pumpspray (nitroglycerin lingual spray) are vasodilators indicated for the prevention of angina pectoris. By clicking send, you acknowledge that you have permission to email the recipient with this information. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. Imdur may interact with sildenafil, other vasodilators, alcohol, calcium channel blockers, and organic nitrates. Modify Therapy/Monitor Closely. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Initially, (e.g., Imdur): 30 mg (as a single 30-mg tablet or as of a 60-mg tablet) or 60 mg (as a single 60-mg tablet) once daily. You are being redirected to acetylcysteine (Antidote) increases effects of isosorbide mononitrate by Other (see comment). Mechanism: additive vasodilation. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. The exact mechanism of action in the relief of angina pectoris has not been fully elucidated. Less frequent administration of isosorbide dinitrate may reduce the development of tolerance to the drugs antianginal effects. Risk of increased SBP, angina pectoris. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Tell your doctor all medications and supplements you use. Use Caution/Monitor. 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. An interdosing interval sufficient to avoid tolerance to Dilatrate-SR extended-release capsules is not known, but it must exceed 18 hours. 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 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. x][7~_cNv2}LN ` 8ql'O_}U%zwZ]U{_U]V?/*S~[~|^bn[zHsxuy][^,;}.oO^mweU^.Wn>{l .6=(r#n*xW7| J{{or`}|4^r Monitor Closely (1)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). isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. Minor/Significance Unknown. Modify Therapy/Monitor Closely. Either increases toxicity of the other by Other (see comment). isosorbide mononitrate, bretylium. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension. Typically applied to chest. 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. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada). The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Minor/Significance Unknown. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. 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. Distribution into human body tissues and fluids has not been fully characterized. 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. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 2 0 obj Other medications may be prescribed by your doctor for these conditions. phenobarbital will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. isosorbide mononitrate increases effects of ergotamine by decreasing metabolism. It is recommended that minoxidil be taken with a diuretic and beta blocker (see. This document does not contain all possible drug interactions. Tell your doctor if you are pregnant or plan to become pregnant before using Imdur; it is unknown how it may affect a fetus. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. Consult your pharmacist or local waste disposal company. Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. 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. Fexinidazole inhibits CYP3A4. Use Caution/Monitor. Minor/Significance Unknown. If you have specific questions regarding a drugs safety, side effects, usage, warnings, etc., you should contact your doctor or pharmacist, or refer to the individual drug monograph details found on the FDA.gov or RxList.com websites for more information. imdur to isordil imdur vs nitro patch. Either increases effects of the other by Mechanism: additive vasodilation. Use Caution/Monitor. 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. 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. isosorbide mononitrate, captopril. Evaluate for loss of therapeutic effect if medication must be coadministered. Isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron) is prescribed for the treatment of angina (heart pain), coronary artery disease, and congestive heart failure. Contraindicated. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. To help you remember, take it at the same times each day. anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Either increases effects of the other by pharmacodynamic synergism. May cause blurred vision and should be discontinued if this symptom occurs. After removing patch, skin may feel warm and appear red. To apply the ointment using one of the applicators, place the applicator on a flat surface, printed side down. Monitor Closely (1)tetracaine, isosorbide mononitrate. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. Use Caution/Monitor. The recommended starting dose of isosorbide mononitrate is 5 to 10 mg of immediate release tablets twice daily. Isosorbide mononitrate - Some of our experts prefer isosorbide mononitrate to dinitrate. Adjust dosage of CYP3A4 substrates, if clinically indicated. Use Caution/Monitor. Minor/Significance Unknown. It does not work fast enough to relieve the pain of an angina attack that has already started. Isosorbide mononitrate extended-release tablets, peak: 34.5 hours. Risk of elevated blood concentrations of isosorbide dinitrate in patients with cirrhosis. May cause a burning or tingling sensation when administered sublingually. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. Known, but it must exceed 18 hours Release and Nitrolingual Pumpspray nitroglycerin... Blockers, and mean arterial pressure ( afterload ), you acknowledge that you have permission to email the with... 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