Potentially fatal hypotension. Isosorbide dinitrate undergoes extensive first-pass metabolism in the liver and considerable extrahepatic metabolism. Avoid or Use Alternate Drug. Monitor Closely (1)etravirine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This document does not contain all possible drug interactions. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Most Avoid or Use Alternate Drug. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Contraindicated. Why Use Isosorbide Dinitrate vs Isosorbide Mononitrate? commonly, these are generic drugs. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. These applicators allow ointment to be absorbed through a much smaller area of skin than that used in any of the reported clinical trials, and the significance of this difference is not known. No more than 3 doses in a 15- to 30-minute period. 3 0 obj The drug comparison information found in this article does not contain any data from clinical trials with human participants or animals performed by any of the drug manufacturers comparing the drugs. This is not a complete list of side effects and others may occur. Possible cross-tolerance to sublingual nitroglycerin during chronic nitrate use. Minoxidil can exacerbate fluid retention in kidney disease. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. Otherwise, call a poison control center right away. All drug information provided on RxList.com is sourced directly from drug monographs published by the U.S. Food and Drug Administration (FDA). The above information is provided for general Share cases and questions with Physicians on Medscape consult. Comes in 4.1g (90 sprays) and 8.5g (230 sprays) bottle. tecovirimat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, fast/irregular/pounding heartbeat.A very serious allergic reaction to this drug is rare. Minor/Significance Unknown. 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. 4 0 obj After . Monitor Closely (1)iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Use Caution/Monitor. In some controlled trials of other organic nitrate formulations, efficacy has declined with time. Sublingual: 2.5-10 mg every 4-6 hours. It has not been studied in liver disease. The drug information provided is intended for reference only and should not be used as a substitute for medical advice. 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. The dose can be increased to 10 mg twice daily after 2 to 3 days. Isosorbide dinitrate and isosorbide mononitrate are mainly excreted in the urine. % Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration. The dinitrates are further metabolized to (non-vasoactive) mononitrates and, ultimately, to glycerol and carbon dioxide. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. The recommended starting dose of isosorbide mononitrate is 5 to 10 mg of immediate release tablets twice daily. Monitor Closely (1)encorafenib, isosorbide mononitrate. 1 - 2 sprays onto or under the tongue at the onset of pain. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Tolerance to nitrate effects develops with chronic exposure. 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. Tell your doctor if this medication stops working well (for example, you have more frequent or worsening chest pain). Safety and effectiveness of Isordil in pediatric patients have not been established. Some conditions may become worse when the drug is suddenly stopped. After 2 weeks of treatment, during a symptom-limited bicycle ergometer exercise test performed 3 h after . Either increases effects of the other by pharmacodynamic synergism. Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. Use Caution/Monitor. Possible hypotension. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Isosorbide mononitrate is used to prevent angina (chest pain) caused by coronary artery disease (heart disease). tazemetostat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. CYP3A4 substrates may require dosage adjustment. Start with lower doses and titrate slowly. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Use Caution/Monitor. Use Caution/Monitor. Other medications may be prescribed by your doctor for these conditions. 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. Dose escalation does not overcome this effect. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. Adjust dosage of CYP3A4 substrates, if clinically indicated. iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Tight, light-resistant containers at 25C; may be exposed to 1530C. cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. %&SC*U]0l TCLg&=|G==!bT=4Er R|qB^RzA-C%#^krR(Luhiy7c+>Vour]ZOf?HV 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. Known hypersensitivity to isosorbide or any ingredient in the respective formulation. Is Low-Dose Aspirin Linked to Risk for Gastric Ulcers? The bioavailability of ISDN varies widely, and it undergoes significant . elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. No more than 3 sprays are recommended within a 15-minute period, 1 spray 5 - 10 minutes prior to engaging in activity, No dose adjustment is necessary in kidney disease. Avoid extremities below the knee or elbow, skin 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. Tell your doctor all medications and supplements you use. Isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron) is prescribed for the treatment of angina (heart pain), coronary artery disease, and congestive heart failure. Contraindicated. Do not rinse or spit for 5 minutes after dosing, 1 tablet every 5 minutes up to a total of 3 tablets, 1 tablet 5 - 10 minutes prior to engaging in activity, Store in original container with cap screwed on tightly, Drug will lose potency when exposed to light and air, Comes in 4.9g (60 sprays) and 12g (200 sprays) bottle. Modify Therapy/Monitor Closely. isosorbide mononitrate, tadalafil. Do not exceed daily Dilatrate-SR dosages of 160 mg (4 capsules). Importance of warning all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potentially severe and life-threatening hemodynamic 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. 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.Lifestyle changes such as dietary changes, exercise, and not smoking may help this drug work better. 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. Isosorbide dinitrate: About 1 hour. 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. Serious - Use Alternative (1)ivosidenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. The antihypertensive therapy immediately before starting ISMN ( Table 1) consisted of 2 to 4 of the following drugs, administered in conventional dosage: diuretics (hydrochlorothiazide 25 to 12.5 mg/d [8 cases], amiloride 5 mg/d [2 cases], indapamide 2.5 mg/d [3 cases], aldactone 50 mg/d [1 case]); -blockers (atenolol 50 to 100 mg/d [4 cases], Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use. Use Caution/Monitor. Take on empty stomach, 30 minutes before meals or 1 hour after meal, Take on empty stomach, 30 minutes before or 1 hour after meal, Extended-release tablet should be swallowed whole; must not be chewed, crushed, or split, elvitegravir/cobicistat/emtricitabine/tenofovir DF. Either increases effects of the other by Mechanism: additive vasodilation. Do not rub into the skin. Modify Therapy/Monitor Closely. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia. Monitor Closely (1)isosorbide mononitrate, captopril. It will remain primed for 6 weeks. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. Contraindicated. Isosorbide mononitrate: Generally, food delays the rate but not the extent of absorption (less than 10%) of conventional or extended-release tablets. And carbon dioxide ; avoid coadministration with sensitive CYP3A substrates isosorbide dinitrate and isosorbide mononitrate by affecting hepatic/intestinal CYP3A4. In controlling chronic stable angina, long-acting nitrates may be prescribed by doctor. Sprays onto or under the tongue at the onset of pain of Isordil pediatric. 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