Angina pectoris in the elderly
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
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.
Basic pharmacology of cardiac drugs
John Edward Boland, David W. M. Muller in 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.
Drug therapy for portal hypertension
Michael JG Farthing, Anne B Ballinger in Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Nitrovasodilators used in the treatment of portal hypertension include isosorbide dinitrate and isosorbide 5-mononitrate. Both have been shown to markedly reduce HVPG in acute administration but significantly less after chronic administration, probably because of the development of partial tolerance.106 Isosorbide- 5-mononitrate, unlike isosorbide dinitrate, has minimal first-pass metabolism, which facilitates its dosage in patients with liver failure and portosystemic shunting. Indeed, this is the only vasodilator that has been evaluated for the prevention of variceal haemorrhage in aRCT.
The role of serum osmolality in Meniere’s disease with acute sensorineural hearing loss
Published in International Journal of Audiology, 2023
Yen-Hui Lee, Yi-Ho Young
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).
Vericiguat for the treatment of heart failure with reduced ejection fraction
Published in Expert Review of Cardiovascular Therapy, 2023
Ahmed K. Siddiqi, Stephen J. Greene, Marat Fudim, Robert J Mentz, Javed Butler, Muhammad Shahzeb Khan
In another randomized, phase-Ib, Vericiguat-Isosorbide Mononitrate Interaction (VISOR) study [27], the hemodynamic effects of co-administration of vericiguat with long-acting nitrates was evaluated. Since both these medications interact with the same NO-sGC-cGMP pathway, it was important to establish any potential PD interactions. Altogether, concomitant therapy with isosorbide mononitrate and vericiguat led to reductions in SBP and DBP, and an increase in HR [27]. Vericiguat had a slightly extra BP lowering effect, mean maximum DBP decrease of (18.4–22.3 mmHg) and (14.0–20.0 mmHg) in the vericiguat and placebo arms; mean maximum seated SBP decrease of (25.7–32.2 mmHg) and (21.0–30.2 mmHg) in the vericiguat and placebo arms, respectively. The isosorbide mononitrate and vericiguat combination was also well tolerated, with no major adverse effects (AEs) [27].
Tailoring the monomers to overcome the shortcomings of current dental resin composites – review
Published in Biomaterial Investigations in Dentistry, 2023
Jingwei He, Lippo Lassila, Sufyan Garoushi, Pekka Vallittu
Since being invented, Bis-GMA, which is a derivative of Bisphenol A (BPA), have dominated as the main monomer in DRCs. BPA is an endocrine-disrupting compound that can cause several diseases [157–161]. Although BPA is not a component of dental materials, and although alternative synthetic routes of Bis-GMA no longer require BPA, several studies still found the presence of BPA in patients’ urine and saliva after dental procedures [162]. Moreover, the latest studies showed that BPA may be released during the grinding and degradation of dental materials [163,164]. Consequently, numerous BPA-free monomers have been developed and used as alternatives to Bis-GMA, and most of them have shown promising properties and great potential in dentistry [74,146,165–177]. However, the estrogenicity of these new developed BPA-free monomers has not been investigated. Jun et al. [178] used isosorbide to synthesize light polymerizable isosorbide-derived biomonomers (ISDBs, as shown in Figure 19) and prepared Bis-GMA free sealants with ISDBs. They found the ISD-based sealants to have properties comparable to a Bis-GMA-based sealant and no estrogenicity. Sun et al. [179,180] tested the estrogenicity of two bio-based phenols and used these two phenols to prepare a series of BPA-free monomers (as shown in Figure 19), after confirming the absence of estrogenicity. Subsequently, they used these monomers to prepare Bis-GMA-free DRCs. Though these Bis-GMA-free DRCs exhibited acceptable physicochemical properties, certain properties still need to be improved to maintain the same level of performance as Bis-GMA-based DRCs.