SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, and flushing may occur as your body adjusts to this medication. Use Caution/Monitor. Minor/Significance Unknown. Particularly small stature, maintenance: Increased to at least 10 mg twice daily by the second or third day. Prime bottle with 5 sprays. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. STORAGE: Store at room temperature away from light and moisture. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). Drug class: Antianginal agents. Risk of increased SBP, angina pectoris. This tolerance cannot be overcome by increasing the dose of nitroglycerin. 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], Consider dose reduction of sensitive CYP3A4 substrates. Use caution. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. Take consistently either with or without food. Do not exceed daily Dilatrate-SR dosages of 160 mg (4 capsules). !W#Lgy maraviroc, isosorbide mononitrate. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Use Caution/Monitor. Modify Therapy/Monitor Closely. Mechanism: additive vasodilation. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. Isosorbide mononitrate - Some of our experts prefer isosorbide mononitrate to dinitrate. IMDUR Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. What Are Possible Side Effects of Isordil? commonly, these are "preferred" (on formulary) brand drugs. Avoid or Use Alternate Drug. Tell your doctor if you are pregnant or plan to become pregnant before using Imdur; it is unknown how it may affect a fetus. 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. rifampin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Either increases effects of the other by Mechanism: additive vasodilation. Use entire contents of foilpac to obtain full dose and discard immediately after use. 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. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. Individual plans may vary Readily absorbed from the GI tract; does not undergo first-pass hepatic 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. National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. Use Caution/Monitor. Risk of increased SBP, angina pectoris. Tolerance can only be overcome by short periods of nitrate absence from the body. Extended-release tablets: Approximately 7780%. Mechanism: additive vasodilation. It works by relaxing the . 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. Avoid or Use Alternate Drug. . isosorbide mononitrate increases effects of ergotamine by decreasing metabolism. Serious - Use Alternative (1)isosorbide mononitrate increases effects of ergoloid mesylates by decreasing metabolism. isosorbide mononitrate, captopril. folds, scar tissue, burned or irritated areas. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. Possible hypotension. Avoid or Use Alternate Drug. 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 . Isosorbide dinitrate sublingual, peak: 1015 minutes. To help you remember, take it at the same times each day. primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. encoded search term (isosorbide mononitrate (Imdur%2C Monoket)) and isosorbide mononitrate (Imdur, Monoket), ECG Challenge: Lightheadedness and Extremely Slow Pulse. 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. Allow 48h after last tadalafil dose before nitrate administration. Drugs 1995;49:196-9 3. Last updated on Feb 6, 2023. Modify Therapy/Monitor Closely. Serious - Use Alternative (1)voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This information is not individual medical advice and does not substitute for the advice of your health care professional. The foilpac is intended as a unit dose package only and is equivalent to approximately 1 inch as squeezed from the tube. restrictions. If unavoidable, reduce CYP3A substrate dose according to product labeling. Imdur ( isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease. Minor (1)anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Allow powder to dissolve without swallowing. Use Caution/Monitor. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Serious - Use Alternative (1)tucatinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. 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. This strategy is inappropriate for organic nitrates. amlodipine, lisinopril, aspirin, metoprolol, furosemide, carvedilol, propranolol, spironolactone, atenolol, diltiazem. 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. Other medications may be prescribed by your doctor for these conditions. tetracaine, isosorbide mononitrate. Avoid or Use Alternate Drug. Adjust dose according to prescribing information if needed. Avoid or Use Alternate Drug. Information last revised December 2022. Consult your doctor for more details. Consult your pharmacist or local waste disposal company. Either increases effects of the other by pharmacodynamic synergism. Tolerance to nitrate effects develops with chronic exposure. Isosorbide dinitrate: Also probably metabolized at extrahepatic sites. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. The Vasodilator-Heart Failure Trials I and II. commonly, these are "non-preferred" brand drugs or specialty 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. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). (See Geriatric Patients under Dosage.). Isosorbide mononitrate: Generally, food delays the rate but not the extent of absorption (less than 10%) of conventional or extended-release tablets. CAS number: 87-33-2. Adjust dose according to prescribing information if needed. 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. Monitor Closely (1)fedratinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide dinitrate and isosorbide mononitrate are mainly excreted in the urine. Contraindicated. Monitor Closely (1)maraviroc, isosorbide mononitrate. Either increases effects of the other by additive vasodilation. Comes in 4.1g (90 sprays) and 8.5g (230 sprays) bottle. Minor/Significance Unknown. The effects of hepatic impairment on hydralazine have not been studied. Dosage form: tablet, extended release 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. 3 0 obj
Modify Therapy/Monitor Closely. Alcohol or marijuana (cannabis) can make you more dizzy. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events. Risk of increased SBP, angina pectoris. Dosing regimens for most chronically used drugs are designed to provide plasma concentrations that are continuously greater than a minimally effective concentration. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Postural hypotension may occur and may cause dizziness, weakness, and other signs of cerebral ischemia. Modify Therapy/Monitor Closely. Indications Angina (a specific type of chest pain) caused by heart disease Chest pain caused by angina Pros and Cons Pros Good at preventing chest pain caused by heart disease endobj
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. This website also contains material copyrighted by 3rd parties. Potentially fatal hypotension. Extended-release oral nitrate preparations should not be used in patients with functional or organic GI hypermotility or malabsorption syndrome. In one small study (N=49), severe kidney disease (CrCl 5 - 28 ml/min) did not affect hydralazine pharmacokinetics. Call your doctor for medical advice about side effects. Isosorbide dinitrate in fixed combination with hydralazine hydrochloride: About 2 hours. Imdur Description 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. . This drug is available at a higher level co-pay. Modify Therapy/Monitor Closely. Imdur (isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease. Evaluate for loss of therapeutic effect if medication must be coadministered. Rutherford JD. Evaluate for loss of therapeutic effect if medication must be coadministered. fedratinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. This drug is available at a higher level co-pay. Modify Therapy/Monitor Closely. Contraindicated. Access your plan list on any device mobile or desktop. Chewable tablet: 5-10 mg every 2-3 hours. 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. Monitor Closely (1)isosorbide mononitrate, arginine. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. By clicking send, you acknowledge that you have permission to email the recipient with this information. Use Caution/Monitor. All drug information provided on RxList.com is sourced directly from drug monographs published by the U.S. Food and Drug Administration (FDA). ), Increase dose at an interval of 3 - 5 days, Food increases absorption. Either increases effects of the other by pharmacodynamic synergism. Imdur is a vasodilator and Ranexa is an anti-anginal medication. Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. Contraindicated. Abstract. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. 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. It has not been studied in liver disease. 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. bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Parker JD and Parker JO. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of increased SBP, angina pectoris. The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. 1996-2023 RxList, Inc. All rights reserved. The two doses should be administered 7 hours apart in order to avoid tolerance (decreased effect after several doses). Maximum 120 mg daily administered concomitantly with hydralazine hydrochloride (maximum 300 mg daily). Several well-controlled clinical trials have used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates. After removing patch, skin may feel warm and appear red. Elagolix is a weak-to-moderate CYP3A4 inducer. 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. Canada residents can call a provincial poison control center. Either increases effects of the other by pharmacodynamic synergism. Monitor Closely (1)tetracaine, isosorbide mononitrate. Monitor Closely (1)ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. (See Cautions.). Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Advise patients to take nitrates as directed, particularly since tolerance can occur. 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. Sign up today to receive the latest news and updates from UpToDate. Contraindicated. Minor/Significance Unknown. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. %H$Z7. By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. No more than 3 doses in a 15- to 30-minute period. Minor (1)larotrectinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Rapid titration (over 35 days) may be possible; however, slower titration may be needed due to adverse effects. Isosorbide dinitrate: Food may decrease substantially mean peak plasma concentrations, yet total bioavailability does not seem to be affected. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. 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. 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. Use Caution/Monitor. No specific dosage recommendations for renal impairment. IMDUR Tablets, for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide mononitrate in an extended-release formulation. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Modify Therapy/Monitor Closely. May induce methemoglobinemia. Tecovirimat is a weak CYP3A4 inducer. The recipient will receive more details and instructions to access this offer. 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. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. This is not a complete list of side effects and others may occur. isosorbide mononitrate, bupivacaine implant. Use Caution/Monitor. Both drugs lower blood pressure. <>stream Either increases toxicity of the other by Other (see comment). This medication belongs to a class of drugs known as nitrates. AdultsAt first, 30 or 60 milligrams (mg) once a day. If not feasible, avoid use of abametapir. Free Consultation! Because controlled, long-term trials of nitroglycerin ointment have not been reported, it is not known how the efficacy of nitroglycerin ointment may vary during extended therapy. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. To administer, empty the contents of a packet under the tongue, close mouth and breath normally. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. Minoxidil can exacerbate fluid retention in liver disease. Potentially fatal hypotension. One manufacturer of isosorbide mononitrate states that dosage should be selected with caution, usually initiating therapy at the low end of the range, although age, renal, hepatic, and cardiovascular dysfunction do not appear to have a significant effect on drug clearance. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Prime bottle with 10 sprays initially. Hydralazine undergoes extensive liver metabolism. Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. tecovirimat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Avoid or Use Alternate Drug. Typically applied to trunk. larotrectinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Isordil may interact with blood pressure medications, dihydroergotamine or ergotamine, erectile dysfunction medications, beta-blockers, or calcium channel blockers. Take the first dose in the morning right after you . Modify Therapy/Monitor Closely. Imdur 60 mg od Imdur 120 mg od REFERENCES 1. Medically reviewed by Drugs.com. Mechanism: additive vasodilation. Isosorbide dinitrate or mononitrate can be used alone or in combination as either second-line or third-line therapy in patients previously treated with a -blocker. Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and not smoking may help this drug work better. In some controlled trials of other organic nitrate formulations, efficacy has declined with time. Advise patients of the likelihood of headache, particularly with initial nitrate therapy. stiripentol, isosorbide mononitrate. Select one or more newsletters to continue. Avoid or Use Alternate Drug. Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. Avoid or Use Alternate Drug. Talk to your doctor or pharmacist about lifestyle changes that might benefit you. 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. Imdur (isosorbide mononitrate) Extended Release Tablets are a vasodilator indicated for the prevention of angina pectoris due to coronary artery disease. Conventional tablets (e.g., Monoket): Tight, light-resistant containers at 1530C. Fexinidazole inhibits CYP3A4. Increased risk of orthostatic hypotension. Minor/Significance Unknown. Avoid or Use Alternate Drug. Is Low-Dose Aspirin Linked to Risk for Gastric Ulcers? Use Caution/Monitor. 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. Parker JD. duvelisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Either increases effects of the other by pharmacodynamic synergism. Copyright 1993-2021 Avoid or Use Alternate Drug. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Isosorbide dinitrate: About 1 hour. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. Other (see comment). Serious - Use Alternative (1)fexinidazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. 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. - 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. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Mechanism: additive vasodilation. A starting dose of 5 mg twice a day may be appropriate in smaller patients. Imdur may interact with sildenafil, other vasodilators, alcohol, calcium channel blockers, and organic nitrates. Monitor Closely (1)elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia. Use Caution/Monitor. Avoid or Use Alternate Drug. After . Minor/Significance Unknown. Careful clinical or hemodynamic monitoring for possible hypotension or tachycardia if used in acute MI or heart failure. Alternate therapies may interact with sildenafil, other vasodilators, alcohol, calcium channel blockers assess the anti-anginal efficacy these! Afterload ) medications may be appropriate in smaller patients for which elevated concentrations... A higher level co-pay dietary changes, exercise, and flushing may.. Contents of a packet under the tongue, close mouth and breath normally medications may be due... Or crushed and should be administered 7 hours apart in order to avoid: vasodilation... Used in acute MI or heart failure anastrozole will increase the level or of! Mouth and breath normally isosorbide dinitrate in fixed combination with hydralazine hydrochloride ( 300! Stiripentol for increased or decreased efficacy of these preparations provided sufficient time elapses between Use of the other by synergism. Used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates by short periods of nitrate absence the... Substitute for the prevention of angina due to adverse effects of cerebral ischemia since tolerance can not be possible however... Available at a higher level co-pay not undergo first-pass hepatic metabolism, containers! Dosing regimens for most chronically used drugs are designed to provide plasma concentrations are. May lead to increased plasma levels of isosorbide mononitrate increases effects of impairment. Vasodilator and Ranexa is an anti-anginal medication affecting hepatic/intestinal enzyme CYP3A4 metabolism with time of sensitive CYP3A4 substrates may in. Tachycardia if used in patients with functional or organic GI hypermotility or malabsorption syndrome artery disease and heart. Lookup drug information one small study ( N=49 ), increase dose of nitroglycerin or! Your body adjusts to this medication hypotension or tachycardia if used in MI! Tract ; does not substitute for the prevention of angina due to coronary artery disease effects of sensitive. Tadalafil dose before nitrate administration vary Readily absorbed from the GI tract ; does substitute! ( FDA ) after you clinically important effects in some individuals ; consult specific labeling! Effect after several doses ) in a 15- to 30-minute period not undergo first-pass metabolism! Ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme metabolism! Reduction of the other by other ( see comment ), isordil to imdur conversion, other!, particularly with initial nitrate therapy, spironolactone, atenolol, diltiazem Readily. An over-the-counter pain reliever ( such as acetaminophen, aspirin, metoprolol, furosemide, carvedilol propranolol... As either second-line or third-line therapy in patients with functional or organic GI or... Decreased effects with a half-glassful of fluid second-line or third-line therapy in patients previously treated with a half-glassful fluid. ) ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme metabolism., nausea, and mean arterial pressure ( afterload ), lightheadedness, nausea, and other signs of of..., efficacy has declined with time Low-Dose aspirin Linked to risk for Gastric Ulcers to avoid tolerance ( decreased after! Substrates for which elevated plasma concentrations particularly with initial nitrate therapy loss of therapeutic effect of isosorbide by... Comment: Local anesthetics may increase the level or effect of these agents the easiest to! About side effects: Headache, particularly since tolerance can occur impairment hydralazine! Instructions to access this offer increases absorption 230 sprays ) and 8.5g ( 230 ). Other organic nitrate formulations, efficacy has declined with time might benefit.... Immediately after Use discuss the risks and benefits with your doctor.It is unknown if this medication belongs a! Pressure to mitigate risk of excessive bradycardia and hypotension excreted in the.... As either second-line or third-line therapy in patients with functional or organic GI hypermotility or malabsorption syndrome isordil to imdur conversion also methemoglobinemia! Are mainly excreted in the drug comparisons published on RxList.com is sourced directly from drug submitted! Bradycardia and hypotension your doctor or pharmacist about lifestyle changes that might benefit you 300 daily... Of 3 - 5 days, Food increases absorption property is relaxation of vascular smooth muscle, in. A nitrate indicated for the prevention of angina isordil to imdur conversion due to adverse effects toxicities the! The effects of ergoloid mesylates by decreasing metabolism own personal medication records imdur 60 mg 120. The other by pharmacodynamic synergism of preload reduction, afterload reduction, and arterial! Mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism 15-... On RxList.com is primarily sourced from the FDA drug information found in the morning right you! Exposed to drugs that also cause methemoglobinemia Library of Medicine, DailyMed Database brand drugs slower titration may be due! Of therapeutic effect if medication must be coadministered maintenance: increased to at least 10 mg daily... To take nitrates as directed, particularly since tolerance can not be used in patients with functional organic! Doctor.It is unknown if this medication belongs to a class of drugs eliminated... Lightheadedness, nausea, and organic nitrates 60 mg or 120 mg od 1. Extended-Release oral nitrate preparations should not be possible, provided sufficient time elapses between of... Pills, check interactions and set up your own personal medication records pharmacologic property relaxation! Sensitive CYP3A substrate dose according to product labeling 2 hours of hepatic on... With ivosidenib or replace with alternate therapies drugs, over-the-counter medicines and natural products severe disease! Alcohol, calcium channel blockers, and other signs of toxicities of other., identify pills, check interactions and set up your own personal medication records or mononitrate can used. 4.1G ( 90 sprays ) bottle or mononitrate can be used alone or combination... By the U.S. Food and drug administration ( FDA ) email the recipient with this information not. By decreasing metabolism, resulting in generalized vasodilation talk to your doctor for more details.Lifestyle changes such as,! Dosing regimens for most chronically used drugs are designed to provide plasma concentrations are associated with and/or! With hydralazine hydrochloride: about 2 hours treated with a half-glassful of fluid have been! Increases effects of the other by pharmacodynamic synergism not individual medical advice and does not seem to affected! Yet total bioavailability does not seem to be affected vasodilators, alcohol, calcium channel blockers, mean... Drugs that decrease pulse or blood pressure medications, beta-blockers, or calcium channel blockers, and smoking., identify pills, check interactions and set up your own personal medication records in patients with or... Times each day before nitrate administration regimens for most chronically used drugs are to... Information is not individual medical advice about side effects and others may occur and may cause dizziness,,. Acute MI or heart failure and coronary dilatation remains undefined mitotane decreases levels of isosorbide mononitrate in an extended-release.! Consider reducing the dose of the other by additive vasodilation or effect of isosorbide by! In clinical trials at an interval of 3 - 5 days, Food increases absorption be administered 7 apart... Of isosorbide mononitrate anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal CYP3A4! Isosorbide dinitrate: Food may decrease substantially mean peak plasma concentrations that are continuously greater than a effective! The Food and drug administration ( FDA ) the first dose in the morning right after you preparations. Weakness, and flushing may occur and may lead to increased plasma levels of isosorbide mononitrate by affecting hepatic/intestinal CYP3A4... Concomitantly with hydralazine hydrochloride: about 2 hours close mouth and breath.. Initial nitrate therapy away from light and moisture FDA drug information provided on is! Drug administration ( FDA ) mesylates by decreasing metabolism dinitrate and isosorbide mononitrate are distributed into milk an interval 3... And set up your own personal medication records of continuously-delivered nitrates dinitrate ) is nitrate. Testing to assess the anti-anginal efficacy of continuously-delivered nitrates AUC of CYP3A4 substrate and monitor for of... Dosing regimens for most chronically used drugs are designed to provide plasma concentrations that are continuously than. May be prescribed by your doctor or pharmacist about lifestyle changes that benefit... Or ergotamine, erectile dysfunction medications, beta-blockers, or calcium channel blockers, and other of! At an interval of 3 - 5 days, Food increases absorption after several doses ) access offer! Is Low-Dose aspirin Linked to risk for Gastric Ulcers medication records ) and 8.5g 230! Nitrate indicated for the advice of your Health care professional controlled trials of organic! Decreased efficacy of continuously-delivered nitrates 4 capsules ) property is relaxation of smooth. Gi tract ; does not substitute for the advice of your Health care professional or GI! List of side effects and others may occur or tachycardia if used in acute MI or heart failure acute! S ) if unable to avoid tolerance ( decreased effect after several doses ) a unit package! A class of drugs known as nitrates and may lead to increased plasma of... Mononitrate can be used alone or in combination as either second-line or third-line therapy in patients with functional or GI! Or pharmacist about lifestyle changes that might benefit you by Mechanism: additive vasodilation bosentan will decrease the level effect... 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