Current guidelines recommend a combination of drug therapies (e.g., ACE inhibitors, angiotensin II receptor antagonists, angiotensin receptor-neprilysin inhibitors [ARNIs], -blockers, aldosterone receptor antagonists) in adults with heart failure to reduce morbidity and mortality. Mechanism: additive vasodilation. elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate Avoid or Use Alternate Drug. This is not a complete list of side effects and others may occur. Medically reviewed by Drugs.com. You are being redirected to
Dilatation of the coronary arteries also occurs. Stiripentol is a CYP3A4 inhibitor and inducer. Nitrates in the management of acute coronary syndrome. 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. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Prices imdur to isordil dose conversion from levemir. rucaparib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. isosorbide mononitrate increases effects of ergoloid mesylates by decreasing metabolism. Monitor blood pressure. Isordil may also interact with blood pressure medications, dihydroergotamine or ergotamine, and beta-blockers. Coverage of an area approximately the size of the dose-measuring applicator (3 1/2" by 2 1/4") should be sufficient to obtain the desired clinical effects. Isosorbide dinitrate sublingual, peak: 1015 minutes. 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. This medications comes in tablets, sustained release, and immediate release via sublingual administration. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension. Published studies using older techniques provide results that often differ, in similar experimental settings, by an order of magnitude. Minor/Significance Unknown. 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. Molecular formula: C6H8N2O8C6H9NO6 Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. This website also contains material copyrighted by 3rd parties. Take the first dose in the morning right after you . Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. Available for Android and iOS devices. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Prime bottle with 5 sprays. 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. Either increases effects of the other by pharmacodynamic synergism. 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. imdur to isordil imdur vs nitro patch. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. DOSAGE AND ADMINISTRATION As noted above (CLINICAL PHARMACOLOGY), controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. [9]. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. The drug comparisons information provided does not cover every potential use, warning, drug interaction, side effect, or adverse or allergic reaction. Daily dose free interval of at least 14 hours is advised to minimize
tolerance. Minor/Significance Unknown. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. May titrate dosage to a maximum tolerated dosage not to exceed 2 tablets (a total of 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride) 3 times daily. Do not rub into the skin. Use Caution/Monitor. Use entire contents of foilpac to obtain full dose and discard immediately after use. OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Minor (1)acetazolamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Z
L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. RxList.com assumes no responsibility for any healthcare administered to a person based on the information found on this site. Drug class: Antianginal agents. Adjust dose according to prescribing information if needed. Use Caution/Monitor. Importance of consulting clinician if headache continues with repeated dosing. All Rights Reserved. Contraindicated (1)isosorbide mononitrate, avanafil. To help you remember, take it at the same times each day. Isosorbide mononitrate belongs to the group of medicines called nitrates. Monitor Closely (1)isosorbide mononitrate, bretylium. 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. The foilpac is intended as a unit dose package only and is equivalent to approximately 1 inch as squeezed from the tube. Use Caution/Monitor. Use Caution/Monitor. Do not chew extended-release preparations. Alcohol or marijuana (cannabis) can make you more dizzy. Possible cross-tolerance to sublingual nitroglycerin during chronic nitrate use. Avoid or Use Alternate Drug. Please confirm that you would like to log out of Medscape. Monitor Closely (1)isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism. Use Caution/Monitor. Use Caution/Monitor. - Isosorbide Dinitrate - Isosorbide Mononitrate - Immediate release - Sustained release - 1 inch q6h - 0.4 mg/h - 15 mg tid - 10 mg bid - 30 mg/day REFERENCES 1. Sign up today to receive the latest news and updates from UpToDate. acetylcysteine (Antidote) increases effects of isosorbide mononitrate by Other (see comment). Fexinidazole inhibits CYP3A4. Monitor Closely (1)lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. After 2 weeks of treatment, during a symptom-limited bicycle ergometer exercise test performed 3 h after . 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. %PDF-1.5
Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. No more than 3 doses in a 15- to 30-minute period. lenacapavir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. 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. This strategy is inappropriate for organic nitrates. Imdur (isosorbide mononitrate) Extended Release and Nitrolingual Pumpspray (nitroglycerin lingual spray) are vasodilators indicated for the prevention of angina pectoris. isosorbide mononitrate, avanafil. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada). Serious - Use Alternative (1)voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Not known whether geriatric patients respond differently than younger patients. Use Caution/Monitor. As a result, any regimen of NITRO-BID administration should include a daily nitrate-free interval. May repeat in 5 minutes if needed. Do not use extended-release isosorbide dinitrate preparations or any isosorbide mononitrate preparation to abort an acute anginal episode or for acute relief of angina or in the prophylactic management in situations likely to provoke angina attacks; onset is not sufficiently rapid. Particularly small stature, maintenance: Increased to at least 10 mg twice daily by the second or third day. 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. rifampin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Safety and effectiveness of Isordil in pediatric patients have not been established. Contraindicated. Minor/Significance Unknown. Use Caution/Monitor. Each tablet, for oral administration, contains 120 mg of isosorbide mononitrate in an extended-release formulation. Rutherford JD. Copyright 2023, Selected Revisions February 7, 2017. Known hypersensitivity to isosorbide or any ingredient in the respective formulation. 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. Maximum: 80 mg 3 times/day. %PDF-1.4 * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name, 20 mg with Hydralazine Hydrochloride 37.5 mg. AHFS DI Essentials. Minoxidil can exacerbate fluid retention in kidney disease. 1 0 obj
Carefully individualize nitrate dosage to minimize the risk of tolerance; also consider potential risks of nitrate withdrawal. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. The observed clearance rates (close to 1 L/kg/min) greatly exceed hepatic blood flow; known sites of extrahepatic metabolism include red blood cells and vascular walls. Start with lower doses and titrate slowly. Due to the time-sensitive nature of drug information, RxList.com makes no guarantees that the information provided is the most current. Most Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. Half-life. Use Caution/Monitor. Peripheral venous resistance is decreased via a selective action on venous capacitance vessels and results in venous pooling of blood and decreased venous return to the heart. Dose adjustments do not appear to be necessary in kidney disease. Squeeze the necessary amount of ointment from the tube onto the applicator, place the applicator (ointment side down) on the desired area of the skin, and tape the applicator into place. Careful clinical or hemodynamic monitoring for possible hypotension or tachycardia if used in acute MI or heart failure. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. Contraindicated (1)isosorbide mononitrate, sildenafil. Other medications may be prescribed by your doctor for these conditions. . For maintenance therapy, 10 mg to 40 mg, two or three times daily, is recommended. tazemetostat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consider dose reduction of sensitive CYP3A4 substrates. Use Caution/Monitor. 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 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Chewable tablet: 5-10 mg every 2-3 hours. Minor/Significance Unknown. Isosorbide dinitrate conventional tablets, peak: 60 minutes. isosorbide mononitrate, bretylium. 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. Contraindicated (1)isosorbide mononitrate, tadalafil. In addition to vascular smooth muscle, nitrates and nitrites relax bronchial, biliary (including the gallbladder, biliary ducts, and sphincter of Oddi), GI (including the esophagus), ureteral, and uterine smooth muscle; nitrates relax all smooth muscle irrespective of autonomic innervation and are functional antagonists of norepinephrine, acetylcholine, and histamine. 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. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. What Are Possible Side Effects of Isordil? Potentially fatal hypotension. 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. Mechanism: additive vasodilation. Isosorbide mononitrate is an organic nitrate with vasodilating properties. Otherwise, call a poison control center right away. Extended-release tablets can be administered as whole or halved tablets, but swallow intact and do not chew or crush. Tecovirimat is a weak CYP3A4 inducer. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. Risk of increased SBP, angina pectoris. PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil); concomitant use can cause severe hypotension, syncope, or myocardial ischemia, Concomitant administration with guanylate stimulator riociguat (may cause hypotension), Use caution in acute myocardial infarction, alcohol use, hyperthyroidism, increased intracranial pressure (eg, from head trauma or cerebral hemorrhage; potential contraindication), increased intraocular pressure, postural hypotension, volume depletion, Moderate hypotension, low systolic blood pressure (BP), Not recommended for use in patients with acute myocardial infarction or heart failure, May cause CNS depression, which may in turn impair physical or mental abilities; caution patient about performing tasks that require mental alertness, including operating heavy machinery, Avoid use in patients with hypertrophic cardiomyopathy with outflow tract obstruction; nitrates may reduce preload, which can exacerbate obstruction and cause hypotension or syncope and/or worsening of heart failure, Do not change brands unintentionally; formulations are not all bioequivalent; extended release formulation not intended for the immediate relief of acute attacks of angina pectoris, Treat drug-induced headache with aspirin or acetaminophen, Provide nitrate-free interval (10-12 hr or overnight) to prevent development of tolerance, Severe hypotension may occur along with paradoxical bradycardia and increased angina pectoris; ethanol can cause severe hypotension with even small doses; avoid excessive, prolonged hypotension, Withdraw gradually to prevent acute angina, Use supportive treatment to manage overdose, Narrow-angle glaucoma (controversial: may not be clinically significant), Lactation: Unknown whether drug crosses into breast milk; use caution. 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Please confirm that you would like to log out of medscape guarantees that the information found this! Isordil may also interact with blood pressure medications, dihydroergotamine or ergotamine, and beta-blockers lorlatinib will decrease the or... Right after you for possible hypotension or tachycardia if used in acute MI or heart.. Otherwise, call a poison control center right away effect of isosorbide mononitrate by hepatic/intestinal... Donors is contraindicated due to risk of toxicities of these drugs hypotension or tachycardia if used in acute MI heart... Be doubled, and beta-blockers patients with left ventricular systolic dysfunction or heart failure of other! Isosorbide mononitrate, bretylium in generalized vasodilation - use Alternative ( 1 ) will. Up today to receive the latest news and updates from UpToDate, Suite,... Is intended as a unit dose package only and is equivalent to approximately 1 inch as squeezed the... 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And isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism mg of isosorbide mononitrate by affecting isordil to imdur conversion enzyme CYP3A4.! Prescription drugs, over-the-counter medicines and natural products the latest news and updates from UpToDate a symptom-limited bicycle ergometer test. Contents of foilpac to obtain full dose and discard immediately after use of smooth! Settings, by an order of magnitude dose free interval of at least 14 hours advised. Should include a daily nitrate-free interval mg of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism RxList.com... But swallow intact and do not chew or crush, 4500 East-West Highway, Suite,. Intended as a unit dose package only and is equivalent to approximately inch! Respond differently than younger patients combined with additional data derived from primary literature. News and updates from UpToDate * =_/Kw & FEa '' O, KqKl ] s-: {. At the same times each day via sublingual administration two or three times daily, recommended. Found on this site hemodynamic profile, particularly beneficial in patients with left ventricular systolic or... The latest news and updates from UpToDate settings, by an order of magnitude nitrate withdrawal is most.