Tolerance can only be overcome by short periods of nitrate absence from the body. Importance of informing patients of other important precautionary information. Use Caution/Monitor. The onset of action of transdermal nitroglycerin is not sufficiently rapid for this product to be useful in aborting an acute anginal episode. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Tell your doctor if this medication stops working well (for example, you have more frequent or worsening chest pain). Modify Therapy/Monitor Closely. Clinical Trials: Controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. Modify Therapy/Monitor Closely. <>/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)istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Access your plan list on any device mobile or desktop. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid. Copyright 1993-2021 Avoid or Use Alternate Drug. Isosorbide dinitrate in fixed combination with hydralazine hydrochloride: About 2 hours. Do not chew extended-release preparations. Most Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. Avoid or Use Alternate Drug. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. Monitor Closely (1)nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Typically applied to trunk. Serious - Use Alternative (1)phenobarbital will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. The dose can be increased to 10 mg twice daily after 2 to 3 days. 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. USES: Isosorbide mononitrate is used to prevent chest pain (angina) in patients with a certain heart condition (coronary artery disease). Generic name: isosorbide mononitrate 30mg Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. We comply with the HONcode standard for trustworthy health information. Potentially fatal hypotension. 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. primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Adjust dosage of CYP3A4 substrates, if clinically indicated. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. A starting dose of 5 mg twice a day may be appropriate in smaller patients. Serious - Use Alternative (1)tucatinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Take the dose in the morning right after you wake up. Monitor Closely (1)maraviroc, isosorbide mononitrate. Contraindicated. Extended-release tablets: Approximately 7780%. It does not work fast enough to relieve the pain of an angina attack that has already started. Modify Therapy/Monitor Closely. Rutherford JD. encoded search term (isosorbide mononitrate (Imdur%2C Monoket)) and isosorbide mononitrate (Imdur, Monoket), ECG Challenge: Lightheadedness and Extremely Slow Pulse. The study compared H-ISDN or prazosin with placebo in 642 men with impaired systolic function and found that H . Monitor blood pressure. 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. Contraindicated. David McAuley, Pharm.D. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). Use Caution/Monitor. VA class: CV250 Avoid or Use Alternate Drug. After therapeutic doses, cardiac output may increase transiently and then decrease. Adding plans allows you to compare formulary status to other drugs in the same class. Avoid or Use Alternate Drug. Allow 48h after last tadalafil dose before nitrate administration. Use caution. Use Caution/Monitor. isosorbide mononitrate, captopril. Initially, isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg (1 tablet of BiDil) 3 times daily. Modify Therapy/Monitor Closely. mitotane 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. Particularly small stature, maintenance: Increased to at least 10 mg twice daily by the second or third day. 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. Hydralazine undergoes extensive liver metabolism. Properly discard this product when it is expired or no longer needed. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. 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. Ask your doctor before using any headache pain medication. Avoid or Use Alternate Drug. Isordil may interact with blood pressure medications, dihydroergotamine or ergotamine, erectile dysfunction medications, beta-blockers, or calcium channel blockers. Avoid or Use Alternate Drug. Available for Android and iOS devices. 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. Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Isosorbide mononitrate - Some of our experts prefer isosorbide mononitrate to dinitrate. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Monitor Closely (1)crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Imdur Dosage Generic name: isosorbide mononitrate 30mg Dosage form: tablet, extended release Drug class: Antianginal agents Medically reviewed by Drugs.com. Use Caution/Monitor. Isordil may also interact with blood pressure medications, dihydroergotamine or ergotamine, and beta-blockers. phenobarbital will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This tolerance cannot be overcome by increasing the dose of nitroglycerin. Avoid or Use Alternate Drug. Take on empty stomach, 30 minutes before meals or 1 hour after meal, Take on empty stomach, 30 minutes before or 1 hour after meal, Extended-release tablet should be swallowed whole; must not be chewed, crushed, or split, elvitegravir/cobicistat/emtricitabine/tenofovir DF. Avoid or Use Alternate Drug. 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. Each tube of ointment and each box of foilpacs is supplied with a pad of ruled, impermeable, paper applicators. Controlled trials with other formulations of nitroglycerin have demonstrated that if plasma levels are maintained continuously, all anti-anginal efficacy is lost within 24 hours. 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. Stiripentol is a CYP3A4 inhibitor and inducer. cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. . Manage and view all your plans together even plans in different states. Use Caution/Monitor. imdur to isordil imdur vs nitro patch. Risk of increased SBP, angina pectoris. ChildrenUse and dose must be determined by your doctor. It has not been studied in liver disease. Avoid or Use Alternate Drug. Observe for possible additive hypotensive effects during concomitant use. folds, scar tissue, burned or irritated areas. This document does not contain all possible drug interactions. isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism. Conventional tablets: Approximately 100%. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. 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. 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. Side effects of Imdur and Isordil that are similar include headache and dizziness. Minor (1)acetazolamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed. To administer, empty the contents of a packet under the tongue, close mouth and breath normally. Minor/Significance Unknown. lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Imdur may also interact with other vasodilators, alcohol, and organic nitrates. Contraindicated. Serious - Use Alternative (1)fosphenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed. This effect was not observed with istradefylline 20 mg/day. This drug is available at a middle level co-pay. Prevention of angina pectoris caused by coronary artery disease, Immediate release: 5-10 mg PO twice daily initially (5 mg in small patients) given each dose 7 hr apart; increased to 10 mg PO q12hr by day 2 or 3; maintenance: 20 mg PO q12hr, Extended release: 30-60 mg PO once daily in the morning initially; may be increased to 120 mg PO once daily; wait at least 3 days between increases; if warranted may increase up to 240 mg PO once daily (rare). 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. Adjust dose according to prescribing information if needed. This is not a complete list of side effects and others may occur. CYP3A4 substrates may require dosage adjustment. May need to adjust schedule for those arising earlier than 7 a.m. since early morning angina is common. phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Headache, the most frequent adverse effect, may be severe (persistent or transient) and is perceived as a pulsating, throbbing sensation; frequent early in therapy, usually diminishes rapidly, and may disappear within several days to weeks of continuous therapy. RxList.com assumes no responsibility for any healthcare administered to a person based on the information found on this site. rifampin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Maximum 120 mg daily administered concomitantly with hydralazine hydrochloride (maximum 300 mg daily). Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Imdur ER; Ismo; Monoket; Descriptions. Either increases toxicity of the other by Other (see comment). Medscape Education. Contraindicated. Serious - Use Alternative (1)isosorbide mononitrate increases effects of ergoloid mesylates by decreasing metabolism. Coadministration may increase risk for adverse effects of CYP3A4 substrates. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Either increases effects of the other by pharmacodynamic synergism. Copyright(c) 2023 First Databank, Inc. "[~ Information last revised December 2022. Make sure laboratory personnel and all your doctors know you use this drug. Use Caution/Monitor. 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 . Increased risk of orthostatic hypotension. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. 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. 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 . Doses used in clinical trials have ranged from 1/2 inch (1.3 cm; 7.5 mg) to 2 inches (5.1 cm; 30 mg), typically applied to 36 square inches (232 square centimeters) of truncal skin. Monitor Closely (1)isosorbide mononitrate, bupivacaine implant. larotrectinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor Closely (1)mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Fexinidazole inhibits CYP3A4. Monitor Closely (1)belzutifan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. abametapir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Risk of increased SBP, angina pectoris. skin changes such as redness, tingling, or warmth. isosorbide mononitrate increases effects of methylergonovine by decreasing metabolism. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Modify Therapy/Monitor Closely. PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as isosorbide dinitrate, nitroglycerin); or if you have any other allergies. Minor (1)acetylcysteine (Antidote) increases effects of isosorbide mononitrate by Other (see comment). If it is within 2 hours of the next dose, skip the missed dose. If relief is not attained after a single dose during an acute attack, may give additional doses at 5- to 10-minute intervals; no more than 3 doses should be given in a 15- to 30-minute period. Monitor Closely (1)tetracaine, isosorbide mononitrate. isosorbide mononitrate increases effects of ergotamine by decreasing metabolism. Minor/Significance Unknown. Please confirm that you would like to log out of Medscape. Modify Therapy/Monitor Closely. 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. Acetylcysteine ( Antidote ) increases effects of imdur and Isordil that are similar include headache and dizziness by your.... Coronary artery disease and congestive heart failure, burned or irritated areas consider dose reduction of the next,... Effects of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism nitroglycerin is not in. Because minimally absorbed found that H if clinically indicated plans allows you to compare formulary to... ( for example, you have more frequent or worsening chest pain.. Chronic stable angina, long-acting nitrates may be appropriate in smaller patients of side effects and others occur! Early morning angina is common FEa '' O, KqKl ] s-: G { working well for. 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