Isosorbide dinitrate conventional tablets, peak: 60 minutes. This site complies with the HONcode standard for trust- worthy health information: verify here. Modify Therapy/Monitor Closely. 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. Use Caution/Monitor. Use Caution/Monitor. Sublingual: 2.5-10 mg every 4-6 hours. Use Caution/Monitor. Keep all medical and lab appointments. Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate Paradoxical bradycardia and angina exacerbation may accompany hypotension. Contraindicated. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. This effect was not observed with istradefylline 20 mg/day. If it is within 2 hours of the next dose, skip the missed dose. Squeeze the necessary amount of ointment from the tube onto the applicator, place the applicator (ointment side down) on the desired area of the skin, and tape the applicator into place. Minor/Significance Unknown. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. flushing (warmth, redness, or tingly feeling). Serious - Use Alternative (1)lofexidine, isosorbide mononitrate. Available for Android and iOS devices. Either increases effects of the other by Mechanism: additive vasodilation. etravirine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid long-acting dosage forms in the early management of acute MI or heart failure since the effects are difficult to terminate rapidly should excessive hypotension or tachycardia occur. Due to the time-sensitive nature of drug information, RxList.com makes no guarantees that the information provided is the most current. Hydralazine undergoes extensive liver metabolism. Avoid or Use Alternate Drug. This medication belongs to a class of drugs known as nitrates. tetracaine, isosorbide mononitrate. tecovirimat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)rucaparib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. It will remain primed for 6 weeks. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. 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 . Subsequent studies discovered that a chemical reaction between . Evaluate for loss of therapeutic effect if medication must be coadministered. View the formulary and any restrictions for each plan. Isosorbide mononitrate extended-release tablets, peak: 34.5 hours. Side effects of Imdur and Ranexa that are similar include headache and dizziness. Congestive heart failure: Oral: Initial: 10 mg 3 times/day. Avoid or Use Alternate Drug. Mechanism: additive vasodilation. Isosorbide dinitrate and isosorbide mononitrate: Organic nitrates; vasodilating agents. Either increases effects of the other by Mechanism: additive vasodilation. The above information is provided for general Modify Therapy/Monitor Closely. %PDF-1.5 Use Caution/Monitor. Isosorbide dinitrate (Isordil) is good for a specific type of chest pain (called angina), but it can cause headaches after you take it. Monitor Closely (1)tetracaine, isosorbide mononitrate. Elagolix is a weak-to-moderate CYP3A4 inducer. It has not been studied in liver disease. Take the dose in the morning right after you wake up. Monitor Closely (1)mitotane decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Monitor Closely (1)lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Serious - Use Alternative (1)isosorbide mononitrate increases effects of ergotamine by decreasing metabolism. May need to adjust schedule for those arising earlier than 7 a.m. since early morning angina is common. Serious - Use Alternative (1)apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. % Drugs 1995;49:196-9 3. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Sign up today to receive the latest news and updates from UpToDate. Clinical Trials: Controlled trials have demonstrated that nitroglycerin ointment can effectively reduce exercise-related angina for up to 7 hours after a single application. May decrease dosage to as little as of the fixed-combination tablet 3 times daily in patients who experience intolerable effects, but attempt to titrate dosage up once adverse effects subside. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information. Either increases toxicity of the other by Other (see comment). For oral dosage form (tablets): Adults20 milligrams (mg) two times a day. Use caution. Recent studies of other formulations of nitroglycerin suggest that the maximal achievable daily duration of anti-anginal effect from nitroglycerin ointment will be about 12 hours. Both direct vasodilatory effects on the coronary bed and drug-induced prevention of episodic coronary artery vasoconstriction increase total coronary blood flow. Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and not smoking may help this drug work better. Last updated on Feb 7, 2022. Advise patients to take nitrates as directed, particularly since tolerance can occur. Isordil may also interact with blood pressure medications, dihydroergotamine or ergotamine, and beta-blockers. (See Selective Phosphodiesterase (PDE) Inhibitors under Cautions.). OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. If you log out, you will be required to enter your username and password the next time you visit. Monitor Closely (1)elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide mononitrate conventional tablets, peak: 0.51 hour. 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. Typically applied to trunk. 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. Modify Therapy/Monitor Closely. This is normal. Maximum: 80 mg 3 times/day. Minoxidil can exacerbate fluid retention in liver disease. Contraindicated. 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. If not feasible, avoid use of abametapir. iloperidone increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated (1)isosorbide mononitrate, avanafil. carbamazepine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 2 0 obj Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. Minor (1)rifapentine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The study compared H-ISDN or prazosin with placebo in 642 men with impaired systolic function and found that H . N Eng J Med 1998;338:520-31 2. Risk of increased SBP, angina pectoris. Monitor CYP3A substrates if coadministered. informational and educational purposes only. Avoid or Use Alternate Drug. Dosing regimens for most chronically used drugs are designed to provide plasma concentrations that are continuously greater than a minimally effective concentration. Imdur (isosorbide mononitrate) Extended Release and Ranexa (ranolazine) are indicated for the prevention of angina pectoris. affecting hepatic/intestinal enzyme CYP3A4 metabolism. May increase dosage to 120 mg (as a single 120-mg tablet or as two 60-mg tablets) once daily after several days; 240-mg dosages rarely needed. You are being redirected to Use Caution/Monitor. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Monitor Closely (1)isosorbide mononitrate increases toxicity of dapsone topical by altering metabolism. Imdur (isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease. Alcohol or marijuana (cannabis) can make you more dizzy. 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. Use Caution/Monitor. '~|4+TYG_X7b0-umj-&0=5Gf37{h73?}vQ8V:/-%c:y S`(0hIk i[j_ {?Mkpr | C+{wC7Rl q3fc(@L0h{a2V,9 y:et/!i!-U*cu6<63l^}W>8V26U;s:u;x=_pTm}FI6hR{AH &VH=0Xa Q@?gB kCRt)tmlx &>AwVqF+|UGFhGEV=AVofypRu"8F=bj Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Any missing drug warnings or information does not in any way guarantee the safety, effectiveness, or the lack of adverse effects of any drug. Potentially fatal hypotension. Use Caution/Monitor. Monitor Closely (1)nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Coadministration of nitrates or nitric oxide donors is contraindicated due to risk of hypotension. Caution if used in nursing women. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. May repeat in 5 minutes if needed. Serious - Use Alternative (1)isosorbide mononitrate increases effects of methylergonovine by decreasing metabolism. . Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. 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. The recommended starting dose of isosorbide mononitrate is 5 to 10 mg of immediate release tablets twice daily. Each day, take the first dose when you wake up, then take the second dose 7 hours later. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. efavirenz will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. 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. Safety and effectiveness of Isordil in pediatric patients have not been established. Isosorbide mononitrate: Metabolized principally in the liver, but unlike isosorbide dinitrate, does not undergo first-pass metabolism; metabolites appear to be pharmacologically inactive. CYP3A4 substrates may require dosage adjustment. Take the first dose in the morning right after you . Each drug may cause hypotension. Initially, isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg (1 tablet of BiDil) 3 times daily. Titrate dosages to levels similar to those recommended for the fixed-combination preparation and administer both drugs at least 3 times daily. %&SC*U]0l TCLg&=|G==!bT=4Er R|qB^RzA-C%#^krR(Luhiy7c+>Vour]ZOf?HV Avoid or Use Alternate Drug. The dinitrates are further metabolized to (non-vasoactive) mononitrates and, ultimately, to glycerol and carbon dioxide. Monitor Closely (1)ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. We comply with the HONcode standard for trustworthy health information. Dose adjustments do not appear to be necessary in kidney disease. May repeat in 5 minutes if needed. The dinitrates are less effective vasodilators than nitroglycerin, but they are longer-lived in the serum, and their net contribution to the overall effect of chronic nitroglycerin regimens is not known. Comes in 4.1g (90 sprays) and 8.5g (230 sprays) bottle. 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. elagolix decreases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. After . Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Modify Therapy/Monitor Closely. Also, it is not intended to be taken just before physical activities (such as exercise or sexual intercourse) to prevent chest pain. Tight, light-resistant containers at room temperature (25C); do not expose to extremes in temperature. Typically applied to chest. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. e5;O"]rQR8ku:mw/CYux:s8ofW`KMb`! Monitor Closely (1)dichlorphenamide and isosorbide mononitrate both decrease serum potassium. 2 0 obj % Do not stop taking it without consulting your doctor. Potentially fatal hypotension. 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. The onset of action of transdermal nitroglycerin is not sufficiently rapid for this product to be useful in aborting an acute anginal episode. Avoid or substitute another drug for these medications when possible. No dose adjustment is necessary in liver disease, Comes in box of 48 one gram foilpacs (one pack is equivalent to one inch of ointment). It is recommended that minoxidil be taken with a diuretic and beta blocker (see minoxidil side effects) May take without regard to food Hair loss (off-label) Dosing: 0.25 - 5 mg once daily See low-dose oral minoxidil for hair loss May take without regard to food Kidney disease Minoxidil can exacerbate fluid retention in kidney disease. Monitor Closely (1)isosorbide mononitrate, arginine. Initially, isosorbide dinitrate conventional tablets (e.g., Isordil Titradose) 520 mg administered 23 times daily, followed by maintenance dosage of 1040 mg administered 23 times daily (some patients may require higher dosages). Serious - Use Alternative (1)fosphenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide dinitrate: Also probably metabolized at extrahepatic sites. Avoid or Use Alternate Drug. Most Tape applicator in place. A local search option of this data can be found here. Mechanism: additive vasodilation. This information is not individual medical advice and does not substitute for the advice of your health care professional. Contraindicated. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). Start with lower doses and titrate slowly. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Controlled studies in pregnant women show no evidence of fetal risk. . The approximate onset and duration of action of various dosage forms of isosorbide dinitrate (ISDN) and isosorbide mononitrate (ISMN) are as follows: Onset and duration of action following intrabuccal administration are probably similar to those after sublingual administration of isosorbide dinitrate. Tell your doctor if you are pregnant or plan to become pregnant before using Imdur; it is unknown how it may affect a fetus. isosorbide mononitrate, vardenafil. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Extended-release tablets can be administered as whole or halved tablets, but swallow intact and do not chew or crush. Properly discard this product when it is expired or no longer needed. It is recommended that minoxidil be taken with a diuretic and beta blocker (see. Use Caution/Monitor. It is unknown if Imdur passes into breast milk. ribociclib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. 1 - 2 sprays on or under the tongue at the onset of pain. In one small study (N=49), severe kidney disease (CrCl 5 - 28 ml/min) did not affect hydralazine pharmacokinetics. You may report side effects to FDA at 1-800-FDA-1088. Avoid or Use Alternate Drug. levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. 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. May shower with patch on. nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. A starting dose of 5 mg twice a day may be appropriate in smaller patients. nitroglycerin rectal, isosorbide mononitrate. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Either increases effects of the other by additive vasodilation. Both drugs lower blood pressure. Isosorbide mononitrate is used to prevent angina (chest pain) caused by coronary artery disease (heart disease). Consider dose reduction of sensitive CYP3A4 substrates. Supplied: Ointment, topical: Nitro-Bid: 2% [20 mg/g] (30 g, 60 g), Supplied: Capsule, extended release: 2.5 mg, 6.5 mg, 9 mg, Supplied: Transdermal system [once daily patch]: 0.1 mg/hour (30s); 0.2 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s), Minitran: 0.1 mg/hour (30s); 0.2 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s), Nitrek: 0.2 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s), Nitro-Dur: 0.1 mg/hour (30s); 0.2 mg/hour (30s); 0.3 mg/hour (30s); 0.4 mg/hour (30s); 0.6 mg/hour (30s); 0.8 mg/hour (30s). Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. endobj Drug Therapy: Nitrate therapy for stable angina pectoris. Use Caution/Monitor. Only after nitrates had been absent from the body for several hours was their anti-anginal efficacy restored. 4 0 obj Serious - Use Alternative (1)phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Selective PDE inhibitors can potentiate the hypotensive effects of organic nitrates and nitrites, possibly resulting in potentially life-threatening hypotension and/or hemodynamic compromise. lorlatinib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)encorafenib, isosorbide mononitrate. MISSED DOSE: If you miss a dose, take it as soon as you remember. Monitor Closely (1)nitroglycerin rectal, isosorbide mononitrate. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Importance of informing patients of other important precautionary information. rifabutin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Parker JO. Avoid or Use Alternate Drug. bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 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. Avoid or Use Alternate Drug. belzutifan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. The recipient will receive more details and instructions to access this offer. Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. Copyright(c) 2023 First Databank, Inc. Peripheral venous resistance is decreased via a selective action on venous capacitance vessels and results in venous pooling of blood and decreased venous return to the heart. isosorbide mononitrate, bretylium. This drug is available at a middle level co-pay. Copyright 2021 GlobalRPH - Web Development by. Monitor blood pressure. Molecular formula: C6H8N2O8C6H9NO6 Avoid or Use Alternate Drug. 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. Am J Cardiol 1993;72:871-6 4. Mechanism: additive vasodilation. May induce methemoglobinemia. IMDUR Tablets, for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide mononitrate in an extended-release formulation. Monitor Closely (1)fedratinib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)duvelisib will increase 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. This drug is available at a higher level co-pay. All Rights Reserved. Avoid or Use Alternate Drug. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. After therapeutic doses, cardiac output may increase transiently and then decrease. Avoid or Use Alternate Drug. 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. 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. Nitrates in the management of acute coronary syndrome. 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. Avoid or Use Alternate Drug. Isosorbide dinitrate sublingual, peak: 1015 minutes. Isosorbide dinitrate fixed-combination tablets with hydralazine hydrochloride, peak: 60 minutes. endobj Contraindicated. encorafenib, isosorbide mononitrate. Common Imdur side effects may include: headache; or. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Use Caution/Monitor. 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. 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. Free Consultation! ;6YXZp2k>!'Z)IfFW`VG@Y!b /r980t ~pE RxList does not provide medical advice, diagnosis or treatment.

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