Evaluate for loss of therapeutic effect if medication must be coadministered. 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. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. Information last revised December 2022. <>>>
Properly discard this product when it is expired or no longer needed. prescription products. Modify Therapy/Monitor Closely. May shower with patch on. Isosorbide mononitrate - Some of our experts prefer isosorbide mononitrate to dinitrate. Coadministration may increase risk for adverse effects of CYP3A4 substrates. Generic name: isosorbide mononitrate 30mg IMDUR Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. No more than 3 doses in a 15- to 30-minute period. Copyright(c) 2023 First Databank, Inc. amlodipine, lisinopril, aspirin, metoprolol, furosemide, carvedilol, propranolol, spironolactone, atenolol, diltiazem. Use Caution/Monitor. Medically reviewed by Drugs.com. Use Caution/Monitor. No specific dosage recommendations for renal impairment. Most Monitor Closely (1)encorafenib, isosorbide mononitrate. Consult your doctor before breast-feeding. Clinical Trials: Controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. Do not change the dosing times unless directed by your doctor.Use this medication regularly to get the most benefit from it. Paradoxical bradycardia and angina exacerbation may accompany hypotension. 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. Molecular formula: C6H8N2O8C6H9NO6 Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Medscape Cardiologist Wealth & Debt Report 2021. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. It does not work fast enough to relieve the pain of an angina attack that has already started. Imdur ER; Ismo; Monoket; Descriptions. Please confirm that you would like to log out of Medscape. 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. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. 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. Otherwise, call a poison control center right away. Other (see comment). Monitor Closely (1)isosorbide mononitrate, captopril. Mechanism: additive vasodilation. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. 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. Potentially fatal hypotension. Monitor Closely (1)isosorbide mononitrate, bretylium. 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. Isosorbide dinitrate is also available in immediate-release (eg, Isordil) and extended-release (eg, Dilatrate-SR) forms. To avoid development of tolerance to nitroglycerin, drug-free intervals of 10 - 12 hours are known to be sufficient; shorter intervals have not been well studied. carbamazepine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Prime bottle with 5 sprays. 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. Use Caution/Monitor. Contraindicated (1)isosorbide mononitrate, sildenafil. 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. Serious - Use Alternative (1)levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. This dose should be increased to 10 mg by the second or third day of therapy. Imdur 60 mg od Imdur 120 mg od REFERENCES 1. Avoid or Use Alternate Drug. * 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. In some controlled trials of other organic nitrate formulations, efficacy has declined with time. 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. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. affecting hepatic/intestinal enzyme CYP3A4 metabolism. This website also contains material copyrighted by 3rd parties. Minor (1)cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Headache is often a sign that this medication is working. It will remain primed for 6 weeks. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. 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. Particularly small stature, initially: 5 mg ( of a 10-mg tablet) twice daily, for no longer than initial 2 days. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Monitor CYP3A substrates if coadministered. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Conventional tablets (e.g., Monoket): Tight, light-resistant containers at 1530C. This is normal. Readily absorbed from the GI tract; does not undergo first-pass hepatic metabolism. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Serious - Use Alternative (1)apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Potentially fatal hypotension. Avoid or Use Alternate Drug. isosorbide mononitrate, bupivacaine implant. Minor (1)acetylcysteine (Antidote) increases effects of isosorbide mononitrate by Other (see comment). tecovirimat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. Modify Therapy/Monitor Closely. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. This drug is available at a middle level co-pay. If unavoidable, reduce CYP3A substrate dose according to product labeling. Use Caution/Monitor. Isosorbide mononitrate: Metabolized principally in the liver, but unlike isosorbide dinitrate, does not undergo first-pass metabolism; metabolites appear to be pharmacologically inactive. To apply the ointment using one of the applicators, place the applicator on a flat surface, printed side down. Use Caution/Monitor. Other medications may be prescribed by your doctor for these conditions. Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. Risk of increased SBP, angina pectoris. Parker JD and Parker JO. Monitor Closely (1)bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Observe for possible additive hypotensive effects during concomitant use. This drug is available at a higher level co-pay. Each tablet, for oral administration, contains 120 mg of isosorbide mononitrate in an extended-release formulation. fexinidazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. CYP3A4 substrates may require dosage adjustment. Isosorbide dinitrate in fixed combination with hydralazine hydrochloride: About 2 hours. Copyright 2023 by RxList Inc. RxList does not provide medical advice, diagnosis or treatment. 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. IMDUR, generics Dosage Forms 100 mg/250 mL premixed bottle - UHN Note: 0.84 mL alcohol per 100 mL solution 100 mcg/mL 200 mcg/mL 400 mcg/mL 10 mg/10 mL . Monitor Closely (1)tetracaine, isosorbide mononitrate. Transient flushing may occur with the nitrates, and inhalation of amyl nitrite commonly causes cutaneous flushing of the head, neck, and clavicular area. By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. Risk of increased SBP, angina pectoris. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Serious - Use Alternative (1)tucatinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism.