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Cardiovascular Drugs
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: It should be used with caution because the pregnancy experience in humans is limited and the reproduction studies in animals have shown low risk. Interestingly, isosorbide dinitrate may be beneficial in inverting the effects of increased vascular resistance to flow in the utero-placental circulation, and the generalized vasoconstriction associated with preeclampsia.
Basic pharmacology of cardiac drugs
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Continuous administration of organic nitrates leads to rapid development of drug tolerance in most patients. In the case of intravenous administration of nitrates, this can generally be overcome simply by increasing the infusion rate. There is good evidence that development of tolerance to transcutaneous nitrate can be largely prevented by the practice of a nitrate-free interval of 10–12 hours per day, most commonly during the night. Similarly, it has been shown that tolerance to the clinical effects of isosorbide mononitrate develops with twice daily dosage but not when the drug is given once daily as recommended.
Angina pectoris in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Wilbert S. Aronow, William H. Frishman
An isosorbide mononitrate is also available for the prevention of angina. The major advantage of the mononitrate preparation is that it is completely bioavailable because it does not undergo first-pass hepatic metabolism. To avoid drug tolerance, it is recommended that the 20–40 mg tablets be given twice daily with 7 hours between doses. A sustained-release formulation of isosorbide mononitrate is also available that provides therapeutic plasma drug concentrations for up to 12 hours each day and low concentrations during the latter part of the 24-hour period. The drug dose range is 30–240 mg given once daily.
The role of serum osmolality in Meniere’s disease with acute sensorineural hearing loss
Published in International Journal of Audiology, 2023
Clinically, the Isosorbide has been utilised to treat EH for decades (Kitahara et al., 1982). By way of elevating the serum osmolality, Isosorbide thus increases the osmotic pressure in the perilymph (Kakigi and Takeda 2009). Since the endolymph volume depends upon the osmotic pressure gradient between the endolymph and perilymph, fluid is transferred from endolymphatic space to perilymphatic space if osmotic pressure in the perilymph is greater than that in the endolymph, and resolution of EH is thus achieved (Figure 1). Conversely, a decrease in serum osmolality may precipitate hydrops formation as shown by acute SNHL in patients with end-stage renal disease during haemodialysis. The pathogenesis of the latter was referred to a rapid decrease in the serum osmolality as evidenced by a recent report (Li, Cheng, and Young, 2020).
New drugs in preclinical and early stage clinical development in the treatment of heart failure
Published in Expert Opinion on Investigational Drugs, 2019
Juan Tamargo, Ricardo Caballero, Eva Delpón
HF is broadly classified into acute (AHF) and chronic (CHF), and also into HF with reduced (≤40%) left ventricular ejection fraction-LVEF (HFrEF), mid-range EF (between 41% and 49%) and preserved (≥50%) ejection fraction (HFpEF) [3]. Over the last 25 years, neurohumoral antagonists, including renin–angiotensin–aldosterone inhibitors [RAASIs: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II AT1 receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs)], β-blockers, and the fixed-dose combination isosorbide dinitrate/hydralazine (FDC I/H), improve symptoms and hemodynamics and reduce morbidity and mortality in HFrEF patients [3,4]. During the same period of time, only one drug was approved for the treatment of AHF by the Food and Drug Administration (FDA; nesiritide) and European Medicines Agency (EMA; levosimendan) [11,12]. More important, even when HFpEF and AHF, defined as new onset or worsening chronic HF (WCHF), is responsible for almost half of all HF-related hospitalizations, no currently approved drug (including neurohumoral antagonists) has been demonstrated to improve long-term outcomes and only few drugs seem to reduce HF hospitalizations (HFH) [3,4,13–15]. This lack of evidence-therapy for HFpEF has been identified as ‘the greatest unmet need in cardiovascular medicine’ [6].
Evaluating the efficacy of outpatient use of isosorbide mononitrate on cervical ripening in pregnant women with unfavourable cervix
Published in Journal of Obstetrics and Gynaecology, 2021
Maryam Kashanian, Solmaz Jangjoo, Narges Sheikhansari, Tayyebeh KaramiAbd
Most studies to date (Thomson et al. 1997; Ekerhovd et al. 2003; Väisänen-Tommiska et al. 2003; Bullarbo et al. 2007; Rameez and Goonewardene 2007; Habib et al. 2008; Bollapragada et al. 2009; Agarwal et al. 2012; Yazdizadeh et al. 2013; Ghosh et al. 2016; Abotorabi et al. 2019) proposed isosorbide mononitrate as a suitable method for cervical ripening which is in agreement with the present study, however, some reported an improvement in different stages of labour (Yazdizadeh et al. 2013), and shorter admission-delivery interval (Habib et al. 2008; Yazdizadeh et al. 2013). In the present study, intervention to delivery interval and the duration of different stages of labour did not show a significant difference in the two groups. Collingham et al. (2010) reported that the addition of vaginal isosorbide mononitrate to oral misoprostol did not reduce time to vaginal delivery and Chanrachakul et al. (2002) found that it was less effective than misoprostol for cervical ripening. Schmitz et al. 2014, showed that isosorbide mononitrate does not reduce caesarean delivery rates, which is in accordance with the present study. Some studies (Bollapragada et al. 2009) found that isosorbide mononitrate does not shorten the admission to delivery interval in comparison to placebo. All of these studies are in agreement with the present study. However, additional data is needed to assess the real impact of NO donors on different stages of labour and its implications. Due to the contradictory results of various studies, more studies should be performed with greater sample size to evaluate its effect on labour duration and reducing caesarean deliveries.