Isordil may interact with blood pressure medications, dihydroergotamine or ergotamine, erectile dysfunction medications, beta-blockers, or calcium channel blockers. National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. You may report side effects to FDA at 1-800-FDA-1088. ~}xp%0Vg^r3WT_a-~qvQD]dvo{,Z@${ssJC j(2GW`_? Minor (1)rifampin 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. Either increases effects of the other by pharmacodynamic synergism. Isosorbide dinitrate: About 1 hour. In one small study (N=49), severe kidney disease (CrCl 5 - 28 ml/min) did not affect hydralazine pharmacokinetics. <> Peak effect: Sublingual tablet: 4-8 minutes; Translingual spray: 4-10 minutes; Buccal tablet: 4-10 minutes; Sustained release: 45-120 minutes; Topical: 30-120 minutes; Transdermal: 60-180 minutes; I.V. Use Caution/Monitor. Monitor Closely (1)lenacapavir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. HOW TO USE: Take this medication by mouth as directed by your doctor, usually twice a day. skin changes such as redness, tingling, or warmth. Nitroglycerin undergoes metabolism in the liver and at sites outside of the liver. Administer extended-release tablets with adequate amounts of fluid (e.g., 120 mL) on arising in the morning. Call your doctor for medical advice about side effects. Contraindicated. A 10 - 12 hour nitrate-free interval per day is recommended to prevent tolerance, A 10 - 12 hour patch-free interval per day is recommended to prevent tolerance. Adjust dose according to prescribing information if needed. Mechanism: additive vasodilation. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low blood pressure.This drug may make you dizzy. Copyright 1993-2021 Avoid or Use Alternate Drug. Isosorbide dinitrate in fixed combination with hydralazine hydrochloride: About 2 hours. elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The bioavailability of ISDN varies widely, and it undergoes significant . If not feasible, avoid use of abametapir. Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Risk of elevated blood concentrations of isosorbide dinitrate in patients with cirrhosis. Hydralazine undergoes extensive liver metabolism. Use Caution/Monitor. May induce methemoglobinemia. Monitor Closely (1)maraviroc, isosorbide mononitrate. Do not use extended-release isosorbide dinitrate preparations or any isosorbide mononitrate preparation to abort an acute anginal episode or for acute relief of angina or in the prophylactic management in situations likely to provoke angina attacks; onset is not sufficiently rapid. Extended-release oral nitrate preparations should not be used in patients with functional or organic GI hypermotility or malabsorption syndrome. Imdur ( isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease. CYP3A4 substrates may require dosage adjustment. Patients who fail to respond to nitroglycerin lingual or sublingual: 2.55 mg of isosorbide dinitrate. Rutherford JD. %PDF-1.5 Contraindicated. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. 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. IMDUR Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. This website also contains material copyrighted by 3rd parties. Mechanism: additive vasodilation. Avoid or Use Alternate Drug. Use Caution/Monitor. Risk of increased SBP, angina pectoris. Avoid or Use Alternate Drug. Isosorbide dinitrate: Also probably metabolized at extrahepatic sites. Minoxidil can exacerbate fluid retention in liver disease. May be re-primed with 2 sprays if not used within 6 weeks. Conversion table Original isosorbide prescription: Convert to: 10 mg twice a day at 8am and 4pm 20 mg twice a day at 8am and 4pm Risk of increased SBP, angina pectoris. carbamazepine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Also, it is not intended to be taken just before physical activities (such as exercise or sexual intercourse) to prevent chest pain. lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Potentially fatal hypotension. If headaches continue or become severe, tell your doctor promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Copyright 2023, Selected Revisions February 7, 2017. May repeat in 5 minutes if needed. daily and increasing to 40 mg three times daily as necessary, given at 8 AM, 1 PM, and 6 PM), isosorbide mononitrate (starting at 30 mg/day in the morning and increasing to 120 mg/day as necessary), or a transdermal. MISSED DOSE: If you miss a dose, take it as soon as you remember. 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. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary. Medscape Education. Isosorbide dinitrate undergoes extensive first-pass metabolism in the liver and considerable extrahepatic metabolism. folds, scar tissue, burned or irritated areas. You may report side effects to Health Canada at 1-866-234-2345. Other (see comment). If relief is not attained after a single dose during an acute attack, may give additional doses at 5- to 10-minute intervals; give no more than 3 doses in a 15- to 30-minute period. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Avoid or Use Alternate Drug. Talk to your doctor or pharmacist about lifestyle changes that might benefit you. 1996-2023 RxList, Inc. All rights reserved. Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Minoxidil can exacerbate fluid retention in kidney disease. Tolerance to nitrate effects develops with chronic exposure. amlodipine, lisinopril, aspirin, metoprolol, furosemide, carvedilol, propranolol, spironolactone, atenolol, diltiazem. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. Use Caution/Monitor. Use Caution/Monitor. istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. CYP3A4 substrates may require dosage adjustment. Use Caution/Monitor. DOSAGE AND ADMINISTRATION As noted above (CLINICAL PHARMACOLOGY), controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. 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. Avoid or Use Alternate Drug. Use Caution/Monitor. primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events. Use Caution/Monitor. In some controlled trials of other organic nitrate formulations, efficacy has declined with time. The addition of a fixed dose of isosorbide dinitrate plus hydralazine to standard therapy for heart failure including neurohormonal blockers is efficacious and increases survival among black. Current guidelines recommend a combination of drug therapies (e.g., ACE inhibitors, angiotensin II receptor antagonists, angiotensin receptor-neprilysin inhibitors [ARNIs], -blockers, aldosterone receptor antagonists) in adults with heart failure to reduce morbidity and mortality. Use Caution/Monitor. Use Caution/Monitor. Readily absorbed from the GI tract; does not undergo first-pass hepatic metabolism. Use Caution/Monitor. Avoid or Use Alternate Drug. acetazolamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Use Caution/Monitor. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Monitor Closely (1)isosorbide mononitrate, arginine. isosorbide mononitrate, captopril. 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. 1 - 2 sprays on or under the tongue at the onset of pain. Aspirin or acetaminophen may relieve. Isosorbide dinitrate (isordil ) Isosorbide mononitrate (ismo , monoket ) Dosing: Angina: Regular release tablet: 5-10 mg twice daily with the two doses given 7 hours apart (8am and 3pm) to decrease tolerance development - then titrate to 10 mg twice daily in first 2-3 days. Monitor blood pressure. Avoid or Use Alternate Drug. Coadministration may increase risk for adverse effects of CYP3A4 substrates. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. tecovirimat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated (1)isosorbide mononitrate, riociguat. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. ACCF and AHA recommend initial dosage of 2030 mg 3 or 4 times daily; give concomitantly with hydralazine hydrochloride 2550 mg 3 or 4 times daily. 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