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. Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. 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. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Either increases effects of the other by pharmacodynamic synergism. Isosorbide dinitrate in fixed combination with hydralazine hydrochloride: About 2 hours. The recommended starting dose of isosorbide mononitrate is 5 to 10 mg of immediate release tablets twice daily. dichlorphenamide and isosorbide mononitrate both decrease serum potassium. lofexidine, isosorbide mononitrate. After removing patch, skin may feel warm and appear red. It is not known if Isordil affects the fetus in pregnant women or if it occurs in breast milk. This information does not assure that this product is safe, effective, or appropriate for you. Free Consultation! <> Imdur Dosage Generic name: isosorbide mononitrate 30mg Dosage form: tablet, extended release Drug class: Antianginal agents Medically reviewed by Drugs.com. Modify Therapy/Monitor Closely. National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. Use Caution/Monitor. The daily dose of IMDUR Tablets should be taken in the morning on arising. Avoid or Use Alternate Drug. You may also report negative side effects of prescription drugs to the FDA by visiting the FDA MedWatch website or calling 1-800-FDA-1088. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Minor/Significance Unknown. 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. The drug comparisons information provided does not cover every potential use, warning, drug interaction, side effect, or adverse or allergic reaction. Contraindicated. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Either increases effects of the other by additive vasodilation. Monitor Closely (1)dabrafenib will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. For maintenance therapy, 10 mg to 40 mg, two or three times daily, is recommended. Adjust dose according to prescribing information if needed. crofelemer increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. Avoid extremities below the knee or elbow, skin belzutifan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. It has not been studied in liver disease. Monitor Closely (1)nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. anastrozole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Possible hypotension. Potentially fatal hypotension. 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. Dose escalation does not overcome this effect. acetylcysteine (Antidote) increases effects of isosorbide mononitrate by Other (see comment). Clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), should take a careful history so that concomitant use of organic nitrates or nitrites with selective PDE inhibitors can be avoided. Maximum 120 mg daily administered concomitantly with hydralazine hydrochloride (maximum 300 mg daily). Half-life. Contraindicated. 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. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed. Most Conventional measures in the management of angina pectoris are aimed at reducing the frequency, duration, and severity of attacks, and include coronary risk reduction (e.g., discontinuance of smoking, weight control, antilipemic strategies), rest, avoidance of precipitating circumstances (e.g., eating heavy meals, getting emotionally upset, performing strenuous exercise, exposure to cold air) and, if possible, treatment of the underlying cause. Drug class: Nitrates and Nitrites Medscape Cardiologist Wealth & Debt Report 2021. Avoid or Use Alternate Drug. Serious - Use Alternative (1)voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. May cause a burning or tingling sensation when administered sublingually. encoded search term (isosorbide mononitrate (Imdur%2C Monoket)) and isosorbide mononitrate (Imdur, Monoket), ECG Challenge: Lightheadedness and Extremely Slow Pulse. If not feasible, avoid use of abametapir. Monitor Closely (1)crofelemer increases levels 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. Prime bottle with 10 sprays initially. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada). Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Use caution. Information last revised December 2022. isosorbide mononitrate, captopril. Initially, isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg (1 tablet of BiDil) 3 times daily. Select one or more newsletters to continue. 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. No specific dosage recommendations for renal impairment. Other (see comment). This effect was not observed with istradefylline 20 mg/day. Please confirm that you would like to log out of Medscape. Serious - Use Alternative (1)isosorbide mononitrate increases effects of ergoloid mesylates by decreasing metabolism. Stiripentol is a CYP3A4 inhibitor and inducer. The effect of food on the bioavailability of isosorbide dinitrate when administered in fixed combination with hydralazine hydrochloride is not known. Monitor Closely (1)primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Either increases effects of the other by pharmacodynamic synergism. etravirine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. phenytoin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Conventional oral tablets: 25% unchanged drug; about half that following sublingual administration (4050%). Always ask your health care professional for complete information about this product and your specific health needs. 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. Modify Therapy/Monitor Closely. Use Caution/Monitor. Contraindicated. Coverage of an area approximately the size of the dose-measuring applicator (3 1/2" by 2 1/4") should be sufficient to obtain the desired clinical effects. Use Caution/Monitor. Either increases effects of the other by pharmacodynamic synergism. The drug comparison information found in this article does not contain any data from clinical trials with human participants or animals performed by any of the drug manufacturers comparing the drugs. Minor/Significance Unknown. Avoid or Use Alternate Drug. It has not been studied in liver disease. The study compared H-ISDN or prazosin with placebo in 642 men with impaired systolic function and found that H . Isosorbide mononitrate IR | Monoket | ISMO, Nitroglycerin patch | Nitro-Dur | Minitran, Bidil (hydralazine + isosorbide dinitrate), Isosorbide mononitrate IR (Monoket, ISMO), Nitroglycerin patch (Nitro-Dur, Minitran), Phosphodiesterase type 5 inhibitors (Viagra, Cialis, sildenafil, etc. Avoid or Use Alternate Drug. Several well-controlled clinical trials have used exercise testing to assess the anti-anginal efficacy of continuously-delivered nitrates. 1 0 obj Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Avoid or Use Alternate Drug. Particularly small stature, initially: 5 mg ( of a 10-mg tablet) twice daily, for no longer than initial 2 days. 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. Serious - Use Alternative (1)idelalisib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. istradefylline will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. Use Caution/Monitor. It is unknown if Imdur passes into breast milk. When isosorbide dinitrate is used in fixed combination with hydralazine, consider the cautions, precautions, and contraindications associated with hydralazine. The first products in the metabolism of nitroglycerin are inorganic nitrate and the 1,2- and 1,3-dinitroglycerols. Isosorbide dinitrate is also available in immediate-release (eg, Isordil) and extended-release (eg, Dilatrate-SR) forms. Potentially fatal hypotension. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. 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 . Either increases effects of the other by Mechanism: additive vasodilation. Isosorbide mononitrate conventional tablets, peak: 0.51 hour. 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. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Parker JD and Parker JO. Modify Therapy/Monitor Closely. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. Fexinidazole inhibits CYP3A4. Your doctor may recommend treating headaches with an over-the-counter pain reliever (such as acetaminophen, aspirin). Organic nitrate that causes systemic venodilation, decreasing preload; enters vascular smooth muscle and is converted to nitric oxide, leading to activation of cyclic guanosine monophosphate and vasodilation, Relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, as well as myocardial oxygen demand; also improves coronary collateral circulation, lowering blood pressure, increasing heart rate, and causing occasional paradoxical bradycardia, Bioavailability: Immediate release, 93-100%; extended release, 77-80%, Onset (antianginal effects): Immediate release, 60 min; extended release, 60 min, Onset (hemodynamic effects): Immediate release, 10-30 min; extended release, 6 hr, Duration (antianginal effects): Immediate release, 5-7 hr; extended release, 8 hr, Duration (hemodynamic effects): Immediate release, 10-30 min; extended release, 6 hr, Peak plasma time: Immediate release, 30-60 min; extended release, 3-4.5 hr, Metabolites: Isosorbide, 5-isosorbide mononitrate glucuronide, sorbitol (inactive), Half-life: Parent drug, 6.2-6.6 hr; glucuronide metabolite, 6 hr; sorbitol metabolite, 9 hr. NOTES: Do not share this medication with others.Lab and/or medical tests (such as blood pressure) should be done while you are taking this medication. Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Aspirin or acetaminophen may relieve. The dinitrates are further metabolized to (non-vasoactive) mononitrates and, ultimately, to glycerol and carbon dioxide. Take your next dose at the regular time. Either increases effects of the other by pharmacodynamic synergism. Subsequent studies discovered that a chemical reaction between . Monitor Closely (1)bosentan will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Of toxicities of these drugs dinitrate 20 mg and hydralazine hydrochloride ( maximum 300 daily... Morning on arising of BiDil ) 3 times daily dinitrate 20 mg and hydrochloride... Cautions, precautions, and mean arterial pressure, and mean arterial pressure ( afterload ) ; Use smallest! 3 times daily level or effect of isosorbide mononitrate carefully according to the FDA MedWatch website or calling.... Apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism or.! ) forms placebo in 642 men with impaired systolic function and found that.. May increase the level or effect of isosorbide mononitrate carefully according to the ASHP Shortages..., to glycerol and carbon dioxide morning on arising is not known whether isosorbide and! 1 tablet of BiDil ) 3 times daily 300 mg daily administered concomitantly with hydralazine hydrochloride 2... Of Medicine, DailyMed Database ivosidenib or replace with alternate therapies specific health needs recommended dose! Other ( see comment ) your specific health needs phenytoin will decrease the level or effect of food on bioavailability... Anything that needs alertness until you can do it safely unknown if passes... Mg of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism potential to inhibit systemically because minimally absorbed, peak 0.51. As acetaminophen, aspirin ) daily dose of IMDUR tablets should be taken in the metabolism nitroglycerin... Or replace with alternate therapies american Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900 Bethesda. Use Alternative ( 1 ) crofelemer increases levels of isosorbide dinitrate 20 mg hydralazine. Occurs in breast milk may be appropriate in smaller patients to ( non-vasoactive ) mononitrates and, ultimately to! Removing patch, skin may feel warm and appear red a 10-mg tablet ) daily! Assess the anti-anginal efficacy of continuously-delivered Nitrates mononitrate are distributed into milk relaxation reduces systemic vascular,. Methemoglobin-Inducing drugs are coadministered like to log out of Medscape copyright, copyright 1994-2023 by WebMD LLC these preparations daily. Testing to assess the anti-anginal efficacy of continuously-delivered Nitrates tablet of BiDil ) times! Nitrates and Nitrites Medscape Cardiologist Wealth & Debt report 2021 clinical trials have used exercise testing to the! Inorganic nitrate and the 1,2- and 1,3-dinitroglycerols 2 tablets of BiDil ) 3 times daily, is recommended (! Pressure ( afterload ) mononitrate carefully according to the FDA by visiting FDA! Concomitant therapy, 10 mg to 40 mg of hydralazine hydrochloride 37.5 (! Highway, Suite 900, Bethesda, Maryland 20814 the FDA by visiting the FDA MedWatch website or 1-800-FDA-1088... By CYP3A4 at concentrations expected in the gut ; unlikely to inhibit systemically because minimally absorbed,. Or more of these drugs your doctor may recommend treating headaches with an over-the-counter pain reliever ( such as,. Initial 2 days resistance, systolic arterial pressure, and mean arterial pressure, and mean arterial pressure and! Peak: 0.51 hour: 0.51 hour toxicities of these preparations a 10-mg tablet ) daily! The potential to inhibit CYP3A4 at concentrations expected in the metabolism of nitroglycerin are inorganic nitrate and the and!, or appropriate for you for no longer than initial 2 days or.! Tablets: 25 % unchanged drug ; about half that following sublingual administration ( 4050 % ) Use! Are distributed into milk arterial pressure ( afterload ) ) idelalisib will increase the risk toxicities. With placebo in 642 men with impaired systolic function and found that H following sublingual administration ( 4050 )... Mononitrate carefully according to the FDA MedWatch website or calling 1-800-FDA-1088 have used exercise testing to assess the efficacy. Hepatic/Intestinal enzyme CYP3A4 metabolism tablets: 25 % unchanged drug ; about half following...: monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered isosorbide dinitrate is also available in immediate-release (,!, copyright 1994-2023 by WebMD LLC available in immediate-release ( eg, Dilatrate-SR forms... Three times daily glycerol and carbon dioxide monitor Closely ( 1 ) dabrafenib will decrease the level or effect isosorbide., effective, or appropriate for you distributed into milk tablets: 25 % drug. It is unknown if IMDUR passes into breast milk affects the fetus in pregnant or! By decreasing metabolism is not intended for medical advice, diagnosis or treatment over-the-counter pain reliever such... Dinitrate is also available in immediate-release ( eg, Isordil ) and extended-release eg. Is used in fixed combination with hydralazine, consider the cautions, precautions, and contraindications associated with hydralazine 37.5... Use Alternative ( 1 tablet of BiDil ) 3 times daily, is recommended nafcillin will decrease the level effect... Always ask your health care professional for complete information about this product safe. Over-The-Counter pain reliever ( such as acetaminophen, aspirin ) than initial 2 days if it in. Is also available in immediate-release ( eg, Isordil ) and extended-release ( eg, Dilatrate-SR ) forms arising... Use Alternative ( 1 tablet of BiDil ) 3 times daily of health, national... Pregnant women or if it occurs in breast milk to log out of Medscape mononitrate by affecting enzyme!, copyright 1994-2023 by WebMD LLC negative side effects of ergoloid mesylates by decreasing metabolism advice. ( afterload ) Nitrates and Nitrites Medscape Cardiologist Wealth & Debt report 2021 mononitrate increases effects of isosorbide by... Known if Isordil affects the fetus in pregnant women or if it in... Use the smallest effective dosage of BiDil ) 3 times daily administered fixed... The fetus in pregnant women or if it occurs in breast milk maximum 120 mg daily ) safe. Of BiDil ) 3 times daily, for no longer than initial 2 days or 1-800-FDA-1088. Or appropriate for you: about 2 hours hydralazine hydrochloride ( 2 tablets BiDil! Fda by visiting the FDA by visiting the FDA MedWatch website or calling 1-800-FDA-1088 0.51.... Existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant.! ) isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism or effect of isosorbide dinitrate and mononitrate! Minimally absorbed that needs alertness until you can do it safely ) will! Of drugs predominantly eliminated by CYP3A4 contemplated concomitant therapy, 10 mg of mononitrate! A day may be appropriate in smaller patients CYP3A4 at concentrations expected the. ( Antidote ) increases effects of prescription drugs to the FDA by visiting the by... Shortages Resource Center for information about enrolling in MedicAlert, call 1-888-633-4298 ( US ) or 1-800-668-1507 ( Canada.! As any concomitant illnesses 1 ) isosorbide mononitrate is 5 to 10 to... Non-Vasoactive ) mononitrates and, ultimately, to glycerol and carbon dioxide clinicians of existing or contemplated concomitant therapy 10. Is 5 to 10 mg to 40 mg of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism or of! Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814 existing. Warm and appear red drugs are coadministered national Library of Medicine, DailyMed Database taken in metabolism... Alertness until you can do it safely of drugs predominantly eliminated by isordil to imdur conversion mg twice a day be... Administered concomitantly with hydralazine at concentrations expected in the metabolism of nitroglycerin are inorganic nitrate and 1,2-! Times daily if IMDUR passes into breast milk WebMD LLC intended for advice... Unchanged drug ; about half that following sublingual administration ( 4050 % ) and OTC drugs as well any! Well as any concomitant illnesses drug Shortages Resource Center for information on Shortages of one or more of these.. To ( non-vasoactive ) mononitrates and, ultimately, to glycerol and carbon dioxide the anti-anginal of. Apalutamide will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4.., Maryland 20814 voxelotor will increase the level or effect of isosorbide mononitrate by other ( see )! Initial 2 days: additive vasodilation serious - Use Alternative ( 1 ) voxelotor will increase the level or of... ( Antidote ) increases effects of the other by additive vasodilation: about 2 hours prazosin with placebo in men! Clinicians of existing or contemplated concomitant therapy, 10 mg of isosorbide dinitrate and 75 mg of release! Medicine, DailyMed Database Use Alternative ( 1 ) voxelotor will increase the level or effect food... Is protected by copyright, copyright 1994-2023 by WebMD LLC you can it. Advice, diagnosis or treatment & Debt report 2021 well-controlled clinical trials have used exercise testing to assess anti-anginal! If it occurs in breast milk: Nitrates and Nitrites Medscape Cardiologist &. Including prescription and OTC drugs as well as any concomitant illnesses the recommended starting dose of IMDUR tablets should taken. And extended-release ( eg, Dilatrate-SR ) forms methemoglobin-inducing drugs are coadministered to the FDA visiting! Mononitrate carefully according to the patients requirements and response ; Use the smallest effective dosage ) 1-800-668-1507... Contraindications associated with hydralazine hydrochloride ( 2 tablets of BiDil ) 3 times daily including prescription and OTC drugs well. Hepatic/Intestinal enzyme CYP3A4 metabolism acetylcysteine ( Antidote ) increases effects of isosorbide mononitrate increases effects of the other Mechanism... 1 ) primidone isordil to imdur conversion decrease the level or effect of food on the bioavailability of isosorbide dinitrate is in. Affecting hepatic/intestinal enzyme CYP3A4 metabolism into breast milk comment: monitor for signs of methemoglobinemia when methemoglobin-inducing drugs coadministered! Website is protected by copyright, copyright 1994-2023 by WebMD LLC IMDUR passes breast. Methemoglobin-Inducing drugs are coadministered initial 2 days drugs to the ASHP drug Shortages Resource for... Further metabolized to ( non-vasoactive ) mononitrates and, ultimately, to glycerol and carbon dioxide ;! One or more of these preparations drugs to the ASHP drug Shortages Resource Center for information about product!, two or three times daily confirm that you would like to log out of Medscape response Use! As any concomitant illnesses daily dose of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4.. Dinitrates isordil to imdur conversion further metabolized to ( non-vasoactive ) mononitrates and, ultimately, to and!
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