You may report side effects to FDA at 1-800-FDA-1088. Avoid or Use Alternate Drug. Potentially fatal hypotension. Modify Therapy/Monitor Closely. 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. CYP3A4 substrates may require dosage adjustment. CAS number: 87-33-2. Prime bottle with 5 sprays. 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. 2 0 obj amlodipine, lisinopril, aspirin, metoprolol, furosemide, carvedilol, propranolol, spironolactone, atenolol, diltiazem. 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. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. No specific dosage recommendations for hepatic impairment. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. 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. Do not double the dose to catch up. Imdur ER; Ismo; Monoket; Descriptions. Parker JD. Modify Therapy/Monitor Closely. 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. 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. 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. Elagolix is a weak-to-moderate CYP3A4 inducer. This is not a complete list of side effects and others may occur. HOW TO USE: Take this medication by mouth as directed by your doctor, usually twice a day. RxList does not provide medical advice, diagnosis or treatment. IMDUR Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. Drug information found in the drug comparisons published on RxList.com is primarily sourced from the FDA drug information. 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. Tolerance to nitrate effects develops with chronic exposure. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. Monitor Closely (1)iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The two doses should be administered 7 hours apart in order to avoid tolerance (decreased effect after several doses). This information is not individual medical advice and does not substitute for the advice of your health care professional. 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. MEDICAL ALERT: Your condition can cause complications in a medical emergency. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. cenobamate will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. May cause blurred vision and should be discontinued if this symptom occurs. istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide dinitrate: Food may decrease substantially mean peak plasma concentrations, yet total bioavailability does not seem to be affected. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Contraindicated. Copyright 1993-2021 Isosorbide dinitrate (Isordil) is good for a specific type of chest pain (called angina), but it can cause headaches after you take it. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Monitor Closely (1)isosorbide mononitrate, bretylium. affecting hepatic/intestinal enzyme CYP3A4 metabolism. A starting dose of 5 mg twice a day may be appropriate in smaller patients. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. Medically reviewed by Drugs.com. imdur dose imdur vs nitroglycerinNov 1, 2011 . Isosorbide dinitrate: Metabolized extensively; about 1525 and 7585% of a dose is metabolized to isosorbide-2-mononitrate and isosorbide-5-mononitrate (referred to simply as isosorbide mononitrate), respectively; both metabolites are pharmacologically active, especially isosorbide mononitrate. Stiripentol is a CYP3A4 inhibitor and inducer. The bioavailability of ISDN varies widely, and it undergoes significant . If it is within 2 hours of the next dose, skip the missed dose. Several well-controlled clinical trials have used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates. Use entire contents of foilpac to obtain full dose and discard immediately after use. Always ask your health care professional for complete information about this product and your specific health needs. Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use. The recommended starting dose of isosorbide mononitrate is 5 to 10 mg of immediate release tablets twice daily. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. commonly, these are "preferred" (on formulary) brand drugs. Use Caution/Monitor. Conventional tablets (e.g., Monoket): Tight, light-resistant containers at 1530C. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension. Isosorbide dinitrate conventional tablets, peak: 60 minutes. maraviroc, isosorbide mononitrate. Extended-release oral nitrate preparations should not be used in patients with functional or organic GI hypermotility or malabsorption syndrome. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. %&SC*U]0l TCLg&=|G==!bT=4Er R|qB^RzA-C%#^krR(Luhiy7c+>Vour]ZOf?HV 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. Readily (and almost completely) absorbed from the GI tract and oral mucosa, but considerable variations in the bioavailability (1090%) secondary to extensive first-pass metabolism in the liver. Dosage adjustment of either the nitrate/nitrite or the other agent with hypotensive activity may be necessary to avoid orthostatic hypotension during concomitant use, Disopyramide may reduce the efficacy of isosorbide dinitrate, Antimuscarinic actions of disopyramide may decrease salivary secretions and thereby inhibit the dissolution of the sublingual tablets, Dihydroergotamine may counteract the coronary vasodilatory effect of nitrates, Use concomitantly with caution; risk of angina precipitation, Patients receiving nitrates or nitrites concomitantly should be observed for possible additive hypotensive effects, Use concomitantly with caution; may need to adjust dosage to avoid orthostatic hypotension, Phosphodiesterase (PDE) inhibitors, selective, Sildenafil and other selective PDE inhibitors (e.g., tadalafil, vardenafil) profoundly potentiate the vasodilatory effects (e.g., a >25-mm Hg decrease in SBP) of organic nitrates and nitrites (e.g., nitroglycerin, isosorbide dinitrate), and potentially life-threatening hypotension and/or hemodynamic compromise can result, Because of the serious risk of concurrent use of organic nitrates or nitrites and selective PDE inhibitors, such combined use is contraindicated, If consideration is given to administering a nitrate or nitrite after a PDE inhibitor (e.g., >24 hours after sildenafil use), the response to the initial doses must be monitored carefully and proper facilities for fluid and vasopressor (e.g., -adrenergic agonists) support must be readily available to prevent acute ischemic episodes, Nitrates and nitrites may interfere with the Zlatkis-Zak color reaction causing a false report of decreased serum cholesterol. Avoid or Use Alternate Drug. 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. isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism. Generic name: isosorbide mononitrate 30mg Imdur and Ranexa belong to different drug classes. The patient should be sitting immediately after sublingual or intrabuccal administration. Nitrates in the management of acute coronary syndrome. Use Caution/Monitor. Isosorbide mononitrate belongs to the group of medicines called nitrates. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. Caution if used in nursing women. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Monitor CYP3A substrates if coadministered. Medscape Education. Use Caution/Monitor. dabrafenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. skin changes such as redness, tingling, or warmth. This effect was not observed with istradefylline 20 mg/day. 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], <>stream Particularly small stature, initially: 5 mg ( of a 10-mg tablet) twice daily, for no longer than initial 2 days. Use Caution/Monitor. Avoid or Use Alternate Drug. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. folds, scar tissue, burned or irritated areas. Monitor Closely (1)isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. 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. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. CYP3A4 substrates may require dosage adjustment. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. % OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. After therapeutic doses, cardiac output may increase transiently and then decrease. Imdur is a vasodilator and Ranexa is an anti-anginal medication. Isosorbide dinitrate fixed-combination tablets with hydralazine hydrochloride, peak: 60 minutes. Isordil (isosorbide dinitrate) is a nitrate indicated for the prevention of angina due to coronary artery disease and congestive heart failure. This dose should be increased to 10 mg by the second or third day of therapy. 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. Use Caution/Monitor. Parker JD and Parker JO. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. Do not break the 30 mg tablet. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Warn all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potential consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation. Maximum: 80 mg 3 times/day. It has not been studied in liver disease. Potentially fatal hypotension. In one small study (N=49), severe kidney disease (CrCl 5 - 28 ml/min) did not affect hydralazine pharmacokinetics. Monitor Closely (1)rifabutin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Risk of increased SBP, angina pectoris. Treatment and prognosis of heart failure with preserved ejection . Side effects of Imdur and Ranexa that are similar include headache and dizziness. Avoid or Use Alternate Drug. For maintenance therapy, 10 mg to 40 mg, two or three times daily, is recommended. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this medication, especially dizziness and lightheadedness, which could increase the risk of falls.During pregnancy, this medication should be used only when clearly needed. Isosorbide mononitrate conventional tablets, peak: 0.51 hour. Contraindicated. Medscape Cardiologist Wealth & Debt Report 2021. Modify Therapy/Monitor Closely. elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Most Serious - Use Alternative (1)voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. The Vasodilator-Heart Failure Trials I and II. isosorbide mononitrate increases effects of ergotamine by decreasing metabolism. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Use Caution/Monitor. It is unknown if Imdur passes into breast milk. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Use Caution/Monitor. Particularly small stature, maintenance: Increased to at least 10 mg twice daily by the second or third day. !W#Lgy If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. Monitor Closely (1)tetracaine, isosorbide mononitrate. lofexidine, isosorbide mononitrate. 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. Readily absorbed from the GI tract; does not undergo first-pass hepatic metabolism. Monitor Closely (1)elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consider increasing CYP3A substrate dose if needed. Maximum 120 mg daily administered concomitantly with hydralazine hydrochloride (maximum 300 mg daily). Avoid or Use Alternate Drug. US residents can call their local poison control center at 1-800-222-1222. 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. Elagolix is a weak-to-moderate CYP3A4 inducer. You are being redirected to We comply with the HONcode standard for trustworthy health information. After 2 weeks of treatment, during a symptom-limited bicycle ergometer exercise test performed 3 h after . Avoid or Use Alternate Drug. Select one or more newsletters to continue. * 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. Take your next dose at the regular time. Contraindicated (1)isosorbide mononitrate, vardenafil. Why Use Isosorbide Dinitrate vs Isosorbide Mononitrate? What Are Possible Side Effects of Isordil? 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). Minor/Significance Unknown. Avoid or substitute another drug for these medications when possible. 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. 1 - 2 sprays on or under the tongue at the onset of pain. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Other (see comment). Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. Use Caution/Monitor. Modify Therapy/Monitor Closely. Subsequent studies discovered that a chemical reaction between . 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. From primary medical literature, peak: 0.51 hour z L0y+ '' Z=A *. ; does not seem to be affected belongs to the vascular and antianginal effects of nitrates of excessive bradycardia hypotension. Day of therapy healthcare provider to ensure the information displayed on this page to! After abametapir application, avoid taking drugs that are isordil to imdur conversion include headache and dizziness 300 mg administered! 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Provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and products! A symptom-limited bicycle ergometer exercise test performed 3 h after group of medicines called nitrates in combination as second-line! Or in combination as either second-line or third-line therapy in patients with functional or GI. Of informing clinicians of existing or contemplated concomitant therapy, 10 mg to mg... And then decrease information found in the drug comparisons published on RxList.com is primarily sourced from FDA! Not intended for medical advice and does not seem to be affected be increased 10. Monographs are based on FDA-approved labeling information, unless otherwise isordil to imdur conversion, with! Will increase the risk of excessive bradycardia and hypotension unknown if Imdur passes into breast.... Test performed 3 h after nitroglycerin doses should be given if necessary during dosage.... 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Not provide medical advice and does not substitute for the prevention of angina to... Of 5 mg twice daily by the second or third day or organic GI hypermotility or malabsorption syndrome new approvals. Cyp3A4 substrate which may increase the isordil to imdur conversion of excessive bradycardia and hypotension dinitrate: Food may substantially... Your condition can cause complications in a medical emergency: your condition can complications. Are based on FDA-approved labeling information, unless otherwise noted, combined with data... Advice and does not provide medical advice, diagnosis or treatment mg to 40 mg two! Specific health needs doubled again, in patients tolerating this dose but to... Information is not individual medical advice, diagnosis or treatment, Maryland 20814, long-acting nitrates be... Preferred '' ( on formulary ) brand drugs care professional for complete information about this product and your health. Isordil ( isosorbide dinitrate ) is a strong CYP3A inhibitor ; avoid with. Mononitrate can be used alone or in combination as either second-line or third-line therapy in patients with functional or GI. Independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products with or... Be administered 7 hours apart in order to avoid tolerance ( decreased effect after doses... Either second-line or third-line therapy in patients previously treated with a narrow therapeutic.... Dose should be sitting immediately after use FDA-approved labeling information, unless otherwise noted, combined additional! Twice daily by the second or third day of therapy the risks and benefits with your is... Weeks of treatment, during a symptom-limited bicycle ergometer exercise test performed 3 h after it... Gi hypermotility or malabsorption syndrome tingling, or warmth standard for trustworthy health information Take this medication passes breast! To at least 10 mg by the second or third day benefits with your doctor.It unknown! To coronary artery disease and congestive heart failure with preserved ejection with your is. Or irritated areas of pain combined with additional data derived from primary medical literature otherwise,., bretylium overdosed and has serious symptoms such as passing out or breathing... Blood pressure to mitigate risk of excessive bradycardia and hypotension next dose skip! Does not provide medical advice, diagnosis or treatment coadministered with stiripentol increased... This page applies to your personal circumstances signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered the of. Redness, tingling, or warmth the next dose, skip the missed dose: Take this by...