Pronunciation:

(eye soe SOR bide mon oh NYE trate)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

Adverse Reactions:

>10%: Central nervous system: Headache (19% to 38%)

1% to 10%:

Central nervous system: Dizziness (3% to 5%)

Gastrointestinal: Nausea/vomiting (2% to 4%)

<1% (Limited to important or life-threatening): Angina pectoris, arrhythmia, atrial fibrillation, hypotension, palpitation, postural hypotension, premature ventricular contractions, supraventricular tachycardia, syncope, pruritus, rash, abdominal pain, diarrhea, dyspepsia, tenesmus, tooth disorder, vomiting, dysuria, impotence, urinary frequency, asthenia, blurred vision, cold sweat, diplopia, edema, malaise, neck stiffness, rigors, agitation, anxiety, confusion, dyscoordination, hypoesthesia, nightmares, bronchitis, pneumonia, upper respiratory tract infection, arthralgia, methemoglobinemia (rare, overdose)

The incidence of hypotension and adverse cardiovascular events may be increased when used in combination with sildenafil (Viagra®).

Overdosage/Toxicology:

Drug Interactions:

CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of isosorbide mononitrate. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.

CYP3A4 inhibitors: May increase the levels/effects of isosorbide mononitrate. Example inhibitors include azole antifungals, ciprofloxacin, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, and verapamil.

Sildenafil, tadalafil, vardenafil: Significant reduction of systolic and diastolic blood pressure with concurrent use (contraindicated). Do not administer sildenafil, tadalafil, or vardenafil within 24 hours of a nitrate preparation.

Ethanol/Nutrition/Herb Interactions:

Stability:

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: 30-60 minutes

Absorption: Nearly complete and low intersubject variability in its pharmacokinetic parameters and plasma concentrations

Metabolism: Hepatic

Half-life elimination: Mononitrate: ~4 hours

Excretion: Urine and feces

Dosage:

Regular tablet: 5-10 mg twice daily with the two doses given 7 hours apart (eg, 8 AM and 3 PM) to decrease tolerance development; then titrate to 10 mg twice daily in first 2-3 days.

Extended release tablet: Initial: 30-60 mg given in morning as a single dose; titrate upward as needed, giving at least 3 days between increases; maximum daily single dose: 240 mg

Dosing adjustment in renal impairment: Not necessary for elderly or patients with altered renal or hepatic function.

Tolerance to nitrate effects develops with chronic exposure. Dose escalation does not overcome this effect. Tolerance can only be overcome by short periods of nitrate absence from the body. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. Recommended dosage regimens incorporate this interval. General recommendations are to take the last dose of short-acting agents no later than 7 PM; administer 2 times/day rather than 4 times/day. Administer sustained release tablet once daily in the morning.

Administration:

Monitoring Parameters:

Patient Education:

Anesthesia and Critical Care Concerns/Other Considerations:

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

Tablet: 10 mg, 20 mg

Ismo®: 20 mg

Monoket®: 10 mg, 20 mg

Tablet, extended release (Imdur®): 30 mg, 60 mg, 120 mg

International Brand Names: