Avoid or Use Alternate Drug. Both drugs lower blood pressure. Side effects of Imdur and Ranexa that are similar include headache and dizziness. 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. Less frequent administration of isosorbide dinitrate may reduce the development of tolerance to the drugs antianginal effects. lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potentially fatal hypotension. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. Use Caution/Monitor. Use Caution/Monitor. Adjust dosage of CYP3A4 substrates, if clinically indicated. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. ribociclib 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 Avoid or Use Alternate Drug. Consult your doctor before breastfeeding. Allow 48h after last tadalafil dose before nitrate administration. Nitrate tolerance in angina therapy. Monitor blood pressure. 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], <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Monitor Closely (1)bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Most Tight, light-resistant containers at 25C; may be exposed to 1530C. Free Consultation! 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. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding before using Isordil. Risk of increased SBP, angina pectoris. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. 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. Either increases toxicity of the other by Other (see comment). Potentially fatal hypotension. Importance of consulting clinician if headache continues with repeated dosing. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate. Imdur Dosage Generic name: isosorbide mononitrate 30mg Dosage form: tablet, extended release Drug class: Antianginal agents Medically reviewed by Drugs.com. Monitor Closely (1)belzutifan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. stiripentol, isosorbide mononitrate. Published studies using older techniques provide results that often differ, in similar experimental settings, by an order of magnitude. Careful clinical or hemodynamic monitoring for possible hypotension or tachycardia if used in acute MI or heart failure. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada). 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. Consult your doctor for more details. MISSED DOSE: If you miss a dose, take it as soon as you remember. Imdur is a vasodilator and Ranexa is an anti-anginal medication. Medscape Education. Minor (1)rifapentine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. [2,3], Hydralazine has not been studied extensively in kidney disease. The first products in the metabolism of nitroglycerin are inorganic nitrate and the 1,2- and 1,3-dinitroglycerols. Increased risk of orthostatic hypotension. 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. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. Use Caution/Monitor. Avoid or Use Alternate Drug. Use Caution/Monitor. Either increases effects of the other by pharmacodynamic synergism. 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 . endobj Nitrates in the management of acute coronary syndrome. Use Caution/Monitor. Isosorbide mononitrate (ismo , monoket ), Isosorbide mononitrate (Ismo , Monoket ), HONcode standard for trust- worthy health, Pediatric Oncology: Diagnosis And Prognosis Communication, Works by relaxation of smooth muscle, producing a vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins. Monitor Closely (1)mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This medication belongs to a class of drugs known as nitrates. Either increases effects of the other by pharmacodynamic synergism. CAS number: 87-33-2. 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). If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. Monitor Closely (1)tetracaine, isosorbide mononitrate. Tell your doctor all medications and supplements you use. Some conditions may become worse when the drug is suddenly stopped. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. Risk of increased SBP, angina pectoris. The patient should be sitting immediately after sublingual or intrabuccal administration. Avoid or Use Alternate Drug. Your doctor may increase your dose as needed. Avoid or Use Alternate Drug. Known hypersensitivity to isosorbide or any ingredient in the respective formulation. Use Caution/Monitor. Potentially fatal hypotension. 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. Mechanism: additive vasodilation. The above information is provided for general Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Minoxidil can exacerbate fluid retention in kidney disease. Use Caution/Monitor. Isordil (isosorbide dinitrate) tablets come in strengths of 5 or 40 mg of isosorbide dinitrate. It will remain primed for 6 weeks. Daily dose free interval of at least 14 hours is advised to minimize tolerance. elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Either increases effects of the other by additive vasodilation. It works by relaxing and widening blood vessels so blood can flow more easily to the heart.This medication will not relieve chest pain once it occurs. crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. No specific dosage recommendations for renal impairment. Your dose may need to be gradually decreased.Although unlikely, when this medication is used for a long time, it may not work as well and may require different dosing. Primarily reduces cardiac oxygen demand by decreasing preload (left ventricular end-diastolic pressure); may modestly reduce afterload; dilates coronary arteries and improves collateral flow to ischemic regions. CYP3A4 substrates may require dosage adjustment. Isosorbide mononitrate extended-release tablets, peak: 34.5 hours. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. Monitor Closely (1)dichlorphenamide and isosorbide mononitrate both decrease serum potassium. 4 0 obj 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. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Modify Therapy/Monitor Closely. Carefully individualize nitrate dosage to minimize the risk of tolerance; also consider potential risks of nitrate withdrawal. Isosorbide dinitrate: About 1 hour. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. <> Avoid or Use Alternate Drug. Also, it is not intended to be taken just before physical activities (such as exercise or sexual intercourse) to prevent chest pain. Rapid titration (over 35 days) may be possible; however, slower titration may be needed due to adverse effects. 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 Either increases effects of the other by additive vasodilation. <>>> Do not stop taking it without consulting your doctor. Modify Therapy/Monitor Closely. All drug information provided on RxList.com is sourced directly from drug monographs published by the U.S. Food and Drug Administration (FDA). Nitroglycerin undergoes metabolism in the liver and at sites outside of the liver. rifampin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Mechanism: additive vasodilation. Use Caution/Monitor. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. 1 - 2 sprays on or under the tongue at the onset of pain. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. Paradoxical bradycardia and angina exacerbation may accompany hypotension. conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: drugs to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), riociguat, vericiguat.Some products have ingredients that could worsen your heart failure. Take your next dose at the regular time. isosorbide mononitrate, riociguat. Modify Therapy/Monitor Closely. Either increases effects of the other by pharmacodynamic synergism. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. 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. Avoid or Use Alternate Drug. Use Caution/Monitor. Other (see comment). The data are consistent, however, in suggesting that nitroglycerin levels rise to steady state within an hour or so of application of ointment, and that after removal of nitroglycerin ointment, levels wane with a half-life of about half an hour. 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. Use Caution/Monitor. To help you remember, take it at the same times each day. Consider increasing CYP3A substrate dose if needed. 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 . Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate You are being redirected to Contact the applicable plan Isosorbide dinitrate fixed-combination tablets with hydralazine hydrochloride, peak: 60 minutes. Avoid or Use Alternate Drug. provider for the most current information. Dose adjustments do not appear to be necessary 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 RxList does not provide medical advice, diagnosis or treatment. After therapeutic doses, cardiac output may increase transiently and then decrease. isosorbide mononitrate, bretylium. Parker JD and Parker JO. The usual starting dose of Isordil Titradose is 5 mg to 20 mg, two or three times daily. Avoid or Use Alternate Drug. Either increases effects of the other by pharmacodynamic synergism. 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. The dose can be increased to 10 mg twice daily after 2 to 3 days. carbamazepine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate. idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Rarely, 240 mg may be required. Avoid or Use Alternate Drug. Mechanism: additive vasodilation. isosorbide mononitrate, bupivacaine implant. Take consistently either with or without food. Fexinidazole inhibits CYP3A4. 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. Monitor Closely (1)rifabutin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Drugs 1995;49:196-9 3. Side effects of Imdur and Isordil that are similar include headache and dizziness. 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. Tecovirimat is a weak CYP3A4 inducer. Minor (1)rifampin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Manufacturers state that selective phosphodiesterase (PDE) inhibitors (e.g., sildenafil, tadalafil, vardenafil) are contraindicated in patients receiving nitrates. Tell your pharmacist what products you are using, and ask how to use them safely (especially cough-and-cold products, diet aids, or NSAIDs such as ibuprofen/naproxen).Isosorbide mononitrate is very similar to isosorbide dinitrate. Avoid or Use Alternate Drug. Sign up today to receive the latest news and updates from UpToDate. Elagolix is a weak-to-moderate CYP3A4 inducer. 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. 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. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Use entire contents of foilpac to obtain full dose and discard immediately after use. Please confirm that you would like to log out of Medscape. Modify Therapy/Monitor Closely. %PDF-1.5 Properly discard this product when it is expired or no longer needed. Risk of increased SBP, angina pectoris. Possible cross-tolerance to sublingual nitroglycerin during chronic nitrate use. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this medication, especially dizziness and lightheadedness, which could increase the risk of falls.During pregnancy, this medication should be used only when clearly needed. The daily dose of IMDUR Tablets should be taken in the morning on arising. Dilatation of the coronary arteries also occurs. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. Use Caution/Monitor. After . Risk of increased SBP, angina pectoris. Isosorbide dinitrate conventional tablets, peak: 60 minutes. Adjust dose according to prescribing information if needed. Compare formulary status to other drugs in the same class. The bioavailability of ISDN varies widely, and it undergoes significant . Modify Therapy/Monitor Closely. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Monitor Closely (1)tazemetostat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. You may report side effects to Health Canada at 1-866-234-2345. The onset of action of transdermal nitroglycerin is not sufficiently rapid for this product to be useful in aborting an acute anginal episode. Isosorbide dinitrate and isosorbide mononitrate are mainly excreted in the urine. Abstract. Use Caution/Monitor. Chewable tablet: 5-10 mg every 2-3 hours. This effect was not observed with istradefylline 20 mg/day. etravirine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. duvelisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Imdur (isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease. Use Caution/Monitor. Elagolix is a weak-to-moderate CYP3A4 inducer. Use Caution/Monitor. Minor/Significance Unknown. 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