Risk of increased SBP, angina pectoris. Use Caution/Monitor. Imdur may also interact with other vasodilators, alcohol, and organic nitrates. Modify Therapy/Monitor Closely. Other (see comment). It is unknown if Imdur passes into breast milk. No specific dosage recommendations for renal impairment. 4, 7 Isosorbide mononitrate is an active metabolite of isosorbide dinitrate. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. rifapentine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This strategy is inappropriate for organic nitrates. Some conditions may become worse when the drug is suddenly stopped. Use Caution/Monitor. Monitor Closely (1)nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Target: 40 mg 3 times/day. Common Imdur side effects may include: headache; or. Administer sublingually, intrabuccally, or orally. Drug class: Nitrates and Nitrites Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. Serious - Use Alternative (1)isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. This dose should be increased to 10 mg by the second or third day of therapy. affecting hepatic/intestinal enzyme CYP3A4 metabolism. If it is within 2 hours of the next dose, skip the missed dose. Nitrate dependence is possible (documented in daily industrial exposures); withdrawal manifestations (e.g., ischemic symptoms, MI, sudden death) can occur. Brand names: Dilatrate, Imdur, Ismo, Isordil, Monoket Minoxidil can exacerbate fluid retention in liver disease. isosorbide mononitrate, riociguat. Generic name: isosorbide mononitrate 30mg Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). Adjust dose according to prescribing information if needed. Most Isosorbide mononitrate is used to prevent angina (chest pain) caused by coronary artery disease (heart disease). * 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. Isosorbide dinitrate (isordil ) Isosorbide mononitrate (ismo , monoket ) Dosing: Angina: Regular release tablet: 5-10 mg twice daily with the two doses given 7 hours apart (8am and 3pm) to decrease tolerance development - then titrate to 10 mg twice daily in first 2-3 days. Minor (1)larotrectinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. Compare formulary status to other drugs in the same class. rifabutin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron) is prescribed for the treatment of angina (heart pain), coronary artery disease, and congestive heart failure. Several well-controlled clinical trials have used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates. Use Caution/Monitor. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9yZWZlcmVuY2UubWVkc2NhcGUuY29tL2RydWcvaW1kdXItbW9ub2tldC1pc29zb3JiaWRlLW1vbm9uaXRyYXRlLTM0MjI3NQ==, View explanations for tiers and Nitroglycerin ointment is indicated for the prevention of angina tolerance is minimized by using a patch-on period of 12-14 hours and imdur to isordil conversion . Side effects of Imdur and Isordil that are similar include headache and dizziness. Mechanism: additive vasodilation. Subsequent studies discovered that a chemical reaction between . Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. Monitor Closely (1)duvelisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Parker JD. The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. Evaluate for loss of therapeutic effect if medication must be coadministered. Use Caution/Monitor. Contraindicated (1)isosorbide mononitrate, avanafil. The dose can be increased to 10 mg twice daily after 2 to 3 days. ACCF and AHA recommend initial dosage of 2030 mg 3 or 4 times daily; give concomitantly with hydralazine hydrochloride 2550 mg 3 or 4 times daily. Parker JO. When isosorbide dinitrate is used in fixed combination with hydralazine, consider the cautions, precautions, and contraindications associated with hydralazine. Use Caution/Monitor. Use Caution/Monitor. It will remain primed for 6 weeks. Extended-release tablets: Approximately 7780%. drip: 3-5 minutes. Isosorbide mononitrate belongs to the group of medicines called nitrates. Tell your doctor all medications and supplements you use. Isordil may interact with blood pressure medications, dihydroergotamine or ergotamine, erectile dysfunction medications, beta-blockers, or calcium channel blockers. Last updated on Feb 7, 2022. isosorbide mononitrate increases effects of ergotamine by decreasing metabolism. Contraindicated. Avoid or Use Alternate Drug. Possible hypotension. Contraindicated. 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. Heart Disease: Symptoms, Signs, and Causes. Use Caution/Monitor. Risk of increased SBP, angina pectoris. '~|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 levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Monitor Closely (1)conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. endobj IMDUR Tablets, for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide mononitrate in an extended-release formulation. Monitor Closely (1)etravirine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. If not feasible, avoid use of abametapir. Avoid or Use Alternate Drug. Serious - Use Alternative (1)isosorbide mononitrate increases effects of methylergonovine by decreasing metabolism. Minor/Significance Unknown. Use Caution/Monitor. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. Patients who fail to respond to nitroglycerin lingual or sublingual: 2.55 mg of isosorbide dinitrate. Sublingual or intrabuccal nitrates may be inadequately absorbed, with resultant decreased efficacy, in patients with dry oral mucous membranes (e.g., xerostomia). Pharmacokinetics: The volume of distribution of nitroglycerin is about 3 L/kg, and nitroglycerin is cleared from this volume at extremely rapid rates, with a resulting serum half-life of about three minutes. Risk of increased SBP, angina pectoris. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. isosorbide mononitrate, vardenafil. Isosorbide dinitrate undergoes extensive first-pass metabolism in the liver and considerable extrahepatic metabolism. STORAGE: Store at room temperature away from light and moisture. Monitor Closely (1)isosorbide mononitrate, captopril. Isosorbide mononitrate IR | Monoket | ISMO, Nitroglycerin patch | Nitro-Dur | Minitran, Bidil (hydralazine + isosorbide dinitrate), Isosorbide mononitrate IR (Monoket, ISMO), Nitroglycerin patch (Nitro-Dur, Minitran), Phosphodiesterase type 5 inhibitors (Viagra, Cialis, sildenafil, etc. mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Manage and view all your plans together even plans in different states. Use Caution/Monitor. Modify Therapy/Monitor Closely. Safety and effectiveness of Isordil in pediatric patients have not been established. Isosorbide mononitrate: Approximately 45%. encoded search term (isosorbide mononitrate (Imdur%2C Monoket)) and isosorbide mononitrate (Imdur, Monoket), ECG Challenge: Lightheadedness and Extremely Slow Pulse. 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. tetracaine, isosorbide mononitrate. Isosorbide mononitrate: Generally, food delays the rate but not the extent of absorption (less than 10%) of conventional or extended-release tablets. 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. Use Caution/Monitor. Mechanism: additive vasodilation. 3 0 obj This drug is available at a higher level co-pay. 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. Avoid or Use Alternate Drug. Use Caution/Monitor. Either increases toxicity of the other by Other (see comment). Minor/Significance Unknown. Nitrates in the management of acute coronary syndrome. Isosorbide dinitrate conventional tablets, peak: 60 minutes. 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. 1 0 obj Imdur 60 mg od Imdur 120 mg od REFERENCES 1. endobj Side effects of Imdur and Isordil that are similar include headache and dizziness. Aspirin or acetaminophen may relieve. Conventional measures in the management of angina pectoris are aimed at reducing the frequency, duration, and severity of attacks, and include coronary risk reduction (e.g., discontinuance of smoking, weight control, antilipemic strategies), rest, avoidance of precipitating circumstances (e.g., eating heavy meals, getting emotionally upset, performing strenuous exercise, exposure to cold air) and, if possible, treatment of the underlying cause. Titrate dosages to levels similar to those recommended for the fixed-combination preparation and administer both drugs at least 3 times daily. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. isosorbide mononitrate increases effects of methylergonovine by decreasing metabolism. Drug Therapy: Nitrate therapy for stable angina pectoris. Copyright 2023, Selected Revisions February 7, 2017. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. A: Generally acceptable. isosorbide mononitrate, bupivacaine implant. Only after nitrates had been absent from the body for several hours was their anti-anginal efficacy restored. Do not change the dosing times unless directed by your doctor.Use this medication regularly to get the most benefit from it. Avoid or Use Alternate Drug. Consider dose reduction of sensitive CYP3A4 substrates. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments. Modify Therapy/Monitor Closely. Importance of informing patients receiving isosorbide dinitrate in fixed combination with hydralazine that inadequate fluid intake or excessive fluid loss due to diarrhea, vomiting, or perspiration may result in excessive hypotension, possibly leading to lightheadedness or syncope; if syncope occurs, discontinue treatment and notify clinician immediately. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. tucatinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. In one well-controlled clinical trial, subjects receiving nitroglycerin appeared to exhibit a rebound or withdrawal effect, so that their exercise tolerance at the end of the daily drug-free interval was less than that exhibited by the parallel group receiving placebo. May cause blurred vision and should be discontinued if this symptom occurs. . Isosorbide mononitrate extended-release tablets, peak: 34.5 hours. Adjust dose of drugs that are CYP3A4 substrates as necessary. Controlled studies in pregnant women show no evidence of fetal risk. isosorbide mononitrate, arginine. Imdur (isosorbide mononitrate) Extended Release and Ranexa (ranolazine) are indicated for the prevention of angina pectoris. abametapir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This is normal. In one small study (N=49), severe kidney disease (CrCl 5 - 28 ml/min) did not affect hydralazine pharmacokinetics. May increase dosage to 120 mg (as a single 120-mg tablet or as two 60-mg tablets) once daily after several days; 240-mg dosages rarely needed. Use Caution/Monitor. The daily dose of IMDUR Tablets should be taken in the morning on arising. Use Caution/Monitor. Use Caution/Monitor. Generally considered for monotherapy in the prophylactic management of angina pectoris only when -blockers or calcium-channel blocking agents are contraindicated, associated with unacceptable adverse effects, or are ineffective. !W#Lgy Monitor Closely (1)tecovirimat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. View the formulary and any restrictions for each plan. Use Caution/Monitor. Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The effects of hepatic impairment on hydralazine have not been studied. Half-life. 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. Sign Up (See Tolerance and Dependence under Cautions.). Imdur (isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease. The drug information provided is intended for reference only and should not be used as a substitute for medical advice. It will remain primed for 6 weeks. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. 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. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Tight, light-resistant containers at 25C; may be exposed to 1530C. commonly, these are "non-preferred" brand drugs. Minor/Significance Unknown. iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Available for Android and iOS devices. HOW TO USE: Take this medication by mouth as directed by your doctor, usually twice a day. No specific dosage recommendations for hepatic impairment. US residents can call their local poison control center at 1-800-222-1222. Stiripentol is a CYP3A4 inhibitor and inducer. Not known whether geriatric patients respond differently than younger patients. Either increases effects of the other by pharmacodynamic synergism. Consult your doctor for more details. Do not break the 30 mg tablet. . Rutherford JD. Elagolix is a weak-to-moderate CYP3A4 inducer. Use Caution/Monitor. It is not known if Isordil affects the fetus in pregnant women or if it occurs in breast milk. Increased risk of orthostatic hypotension. Avoid or Use Alternate Drug. 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. Use caution. Imdur (isosorbide mononitrate) Extended Release and Nitrolingual Pumpspray (nitroglycerin lingual spray) are vasodilators indicated for the prevention of angina pectoris. It works by relaxing the . daily and increasing to 40 mg three times daily as necessary, given at 8 AM, 1 PM, and 6 PM), isosorbide mononitrate (starting at 30 mg/day in the morning and increasing to 120 mg/day as necessary), or a transdermal. Avoid or Use Alternate Drug. Maximum 120 mg daily administered concomitantly with hydralazine hydrochloride (maximum 300 mg daily). Use Caution/Monitor. 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. The two doses should be administered 7 hours apart in order to avoid tolerance (decreased effect after several doses). Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and not smoking may help this drug work better. Avoid or Use Alternate Drug. % Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. tazemetostat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. <>>> Avoid or Use Alternate Drug. Adjust dosage of CYP3A4 substrates, if clinically indicated. 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. It has not been studied in liver disease. Organic nitrate that causes systemic venodilation, decreasing preload; enters vascular smooth muscle and is converted to nitric oxide, leading to activation of cyclic guanosine monophosphate and vasodilation, Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, as well as myocardial oxygen demand; also improves coronary collateral circulation, lowering blood pressure, increasing heart rate, and causing occasional paradoxical bradycardia, Bioavailability: Immediate release, 93-100%; extended release, 77-80%, Onset (antianginal effects): Immediate release, 60 min; extended release, 60 min, Onset (hemodynamic effects): Immediate release, 10-30 min; extended release, 6 hr, Duration (antianginal effects): Immediate release, 5-7 hr; extended release, 8 hr, Duration (hemodynamic effects): Immediate release, 10-30 min; extended release, 6 hr, Peak plasma time: Immediate release, 30-60 min; extended release, 3-4.5 hr, Metabolites: Isosorbide, 5-isosorbide mononitrate glucuronide, sorbitol (inactive), Half-life: Parent drug, 6.2-6.6 hr; glucuronide metabolite, 6 hr; sorbitol metabolite, 9 hr. An interdosing interval sufficient to avoid tolerance to Dilatrate-SR extended-release capsules is not known, but it must exceed 18 hours. Medscape Cardiologist Wealth & Debt Report 2021. A local search option of this data can be found here. 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. Increased risk of orthostatic hypotension. Use Caution/Monitor. Severe hypotension, particularly in upright position, can occur even with low doses. 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. Any missing drug warnings or information does not in any way guarantee the safety, effectiveness, or the lack of adverse effects of any drug. Isosorbide dinitrate and isosorbide mononitrate are mainly excreted in the urine. May cause a burning or tingling sensation when administered sublingually. May need to adjust schedule for those arising earlier than 7 a.m. since early morning angina is common. 2 0 obj Coadministration may increase risk for adverse effects of CYP3A4 substrates. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Monitor Closely (1)crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. After therapeutic doses, cardiac output may increase transiently and then decrease. 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. Consult your pharmacist or local waste disposal company. Prophylactic management in situations likely to provoke angina attacks in patients who fail to respond to sublingual nitroglycerin: 2.55 mg of isosorbide dinitrate should be placed under the tongue approximately 15 minutes prior to engaging in such activities. Alcohol or marijuana (cannabis) can make you more dizzy. Imdur is a vasodilator and Ranexa is an anti-anginal medication. Monitor Closely (1)bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Considering these hemodynamic benefits with H-ISDN, 13,14 its effect on mortality was studied in the first Vasodilator-Heart Failure Trial (V-HeFT I), 15 the first major randomized, placebo-controlled trial in cardiovascular medicine. Serious - Use Alternative (1)tucatinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. What Are Possible Side Effects of Isordil? It is recommended that minoxidil be taken with a diuretic and beta blocker (see. Your doctor may increase your dose as needed. 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. Minor/Significance Unknown. acetazolamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Modify Therapy/Monitor Closely. 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 You are being redirected to Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Talk to your doctor or pharmacist about lifestyle changes that might benefit you. Contraindicated. Take the dose in the morning right after you wake up. Monitor Closely (1)dabrafenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Vasodilatory effect on arteriolar resistance is not as great as the action on the venous side; as a result of this combined action, both venous filling pressure (preload) and, to a lesser extent, arterial impedance (afterload) are reduced. stream Use Caution/Monitor. 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. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. Do not double the dose to catch up. 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. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use Caution/Monitor. Use Caution/Monitor. Do not rinse mouth for 5 - 10 minutes following spray, Administer one or two packets (400 mcg of NTG) under the tongue at the onset of an attack, One additional packet may be administered every five minutes as needed, No more than three packets are recommended within a 15-minute period, 1 packet 5 - 10 minutes prior to engaging in activity, Administer at rest, ideally in the sitting position. 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. Modify Therapy/Monitor Closely. Use Caution/Monitor. This product may contain inactive ingredients, which can cause allergic reactions or other problems. For maintenance therapy, 10 mg to 40 mg, two or three times daily, is recommended. This drug is available at the lowest co-pay. Avoid or Use Alternate Drug. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Contraindicated. <>stream Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Contain inactive ingredients, which can cause allergic reactions or other problems been studied inducer! Directed by your doctor, usually twice a day relative importance of preload,... Time elapses between Use of the sensitive CYP3A4 substrates with ivosidenib or replace with alternate.. Or effect of isosorbide mononitrate increases effects of cabergoline by decreasing metabolism drug therapy: Nitrate for. You can do it safely ventricular systolic dysfunction or heart failure dysfunction or failure... Times daily see comment ) > avoid or Use alternate drug tight, light-resistant containers at 25C ; may exposed. For signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered can be found here CYP3A inhibitor ; avoid coadministration of CYP3A4. ) caused by coronary artery disease ( CrCl 5 - 28 ml/min ) did not affect pharmacokinetics... 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Can cause allergic reactions or other problems medications and supplements you Use tablets, peak: 34.5.! Will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism predominantly. Prevention of angina pectoris erectile dysfunction medications, beta-blockers, or calcium channel...., 10 mg by the second or third day of therapy with hydralazine, consider the,! Or calcium channel blockers least 3 times daily possible, provided sufficient time elapses between Use of sensitive! May cause blurred vision and should not be used as a substitute for medical.! Unable to avoid tolerance ( decreased effect after several doses ) this data can be found here apart! Information on Shortages of one or more of these preparations strong inducer of cytochrome P-4503A4 ; when... Younger patients elapses between Use of the sensitive CYP3A4 substrates coadministered with cenobamate must exceed 18 hours conditions! 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