Consider increasing CYP3A substrate dose if needed. This website also contains material copyrighted by 3rd parties. Modify Therapy/Monitor Closely. Use Caution/Monitor. Comment: Acetylcysteine may enhance vasodilatory effects of nitrates. Imdur may also interact with other vasodilators, alcohol, and organic nitrates. This medications comes in tablets, sustained release, and immediate release via sublingual administration. primidone will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. Risk of increased SBP, angina pectoris. Comment: Monitor for signs of methemoglobinemia when methemoglobin-inducing drugs are coadministered. This site complies with the HONcode standard for trust- worthy health information: verify here. 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. nafcillin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration may increase risk for adverse effects of CYP3A4 substrates. The data are consistent, however, in suggesting that nitroglycerin levels rise to steady state within an hour or so of application of ointment, and that after removal of nitroglycerin ointment, levels wane with a half-life of about half an hour. Tell your doctor all medications and supplements you use. 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. IMDUR Tablets, for oral administration, contain either 30 mg, 60 mg or 120 mg of isosorbide mononitrate in an extended-release formulation. After 2 weeks of treatment, during a symptom-limited bicycle ergometer exercise test performed 3 h after . Conversion table Original isosorbide prescription: Convert to: 10 mg twice a day at 8am and 4pm 20 mg twice a day at 8am and 4pm 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. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Use Caution/Monitor. Short periods (10-12 hours) of nitrate withdrawal help minimize tolerance. Safety and effectiveness of Isordil in pediatric patients have not been established. Avoid or Use Alternate Drug. Monitor CYP3A substrates if coadministered. lofexidine, isosorbide mononitrate. 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. May repeat in 5 minutes if needed. It is reasonable to believe that the rate and extent of nitroglycerin absorption from ointment may vary with the site and square measure of the skin over which a given dose of ointment is spread, but these relationships have not been adequately studied. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Do not store in the bathroom. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Abstract. Importance of clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), to take a careful history so that concomitant use with selective PDE inhibitors can be avoided. (See Selective Phosphodiesterase (PDE) Inhibitors under Cautions.). Modify Therapy/Monitor Closely. Minor (1)cyclophosphamide will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. Importance of informing patients receiving isosorbide dinitrate in fixed combination with hydralazine that inadequate fluid intake or excessive fluid loss due to diarrhea, vomiting, or perspiration may result in excessive hypotension, possibly leading to lightheadedness or syncope; if syncope occurs, discontinue treatment and notify clinician immediately. Patients who fail to respond to nitroglycerin lingual or sublingual: 2.55 mg of isosorbide dinitrate. Maximum: 80 mg 3 times/day. Individual plans may vary Molecular formula: C6H8N2O8C6H9NO6 Imdur and Ranexa belong to different drug classes. 1 0 obj Avoid or Use Alternate Drug. Mechanism: additive vasodilation. Monitor Closely (1)tecovirimat will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Isosorbide dinitrate is also available in immediate-release (eg, Isordil) and extended-release (eg, Dilatrate-SR) forms. %PDF-1.5 RxList.com assumes no responsibility for any healthcare administered to a person based on the information found on this site. Consult your doctor for more details.Lifestyle changes such as dietary changes, exercise, and not smoking may help this drug work better. The antihypertensive therapy immediately before starting ISMN ( Table 1) consisted of 2 to 4 of the following drugs, administered in conventional dosage: diuretics (hydrochlorothiazide 25 to 12.5 mg/d [8 cases], amiloride 5 mg/d [2 cases], indapamide 2.5 mg/d [3 cases], aldactone 50 mg/d [1 case]); -blockers (atenolol 50 to 100 mg/d [4 cases], In the large majority of these trials, active agents were indistinguishable from placebo after 24 hours (or less) of continuous therapy. Serious - Use Alternative (1)levoketoconazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)cenobamate will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Modify Therapy/Monitor Closely. Isosorbide dinitrate or mononitrate can be used alone or in combination as either second-line or third-line therapy in patients previously treated with a -blocker. Available for Android and iOS devices. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. Information last revised December 2022. If unavoidable, reduce CYP3A substrate dose according to product labeling. 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. Daily dose free interval of at least 14 hours is advised to minimize tolerance. Possible cross-tolerance to sublingual nitroglycerin during chronic nitrate use. The onset of action of transdermal nitroglycerin is not sufficiently rapid for this product to be useful in aborting an acute anginal episode. It works by relaxing and widening blood vessels so blood can flow more easily to the heart.This medication will not relieve chest pain once it occurs. isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. The level of glutathione S-transferases (GSH-ST) determined by following the reactions with of 1-chloro-2,4-dinitrobenzene (CDNB), o-dinitrobenzene (o-DNB) or . Avoid or Use Alternate Drug. Conventional oral tablets: 25% unchanged drug; about half that following sublingual administration (4050%). CYP3A4 substrates may require dosage adjustment. Each tablet, for oral administration, contains 120 mg of isosorbide mononitrate in an extended-release formulation. Monitor Closely (1)rucaparib will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. imdur dose imdur vs nitroglycerinNov 1, 2011 . Contraindicated. - Isosorbide Dinitrate - Isosorbide Mononitrate - Immediate release - Sustained release - 1 inch q6h - 0.4 mg/h - 15 mg tid - 10 mg bid - 30 mg/day REFERENCES 1. isosorbide mononitrate, sildenafil. PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to similar drugs (such as isosorbide dinitrate, nitroglycerin); or if you have any other allergies. Imdur may interact with sildenafil, other vasodilators, alcohol, calcium channel blockers, and organic nitrates. We comply with the HONcode standard for trustworthy health information. Use Caution/Monitor. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Adjust dose according to prescribing information if needed. tetracaine, isosorbide mononitrate. This dose should be increased to 10 mg by the second or third day of therapy. CAS number: 87-33-2. Modify Therapy/Monitor Closely. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Both drugs lower blood pressure. -Adrenergic blocking agents (-blockers) generally are considered among the initial antianginal drugs of choice in the long-term prophylactic management of chronic stable angina with or without prior MI to reduce symptoms and to prevent MI and/or death. Minor/Significance Unknown. Nitroglycerin ointment is indicated for the prevention of angina tolerance is minimized by using a patch-on period of 12-14 hours and imdur to isordil conversion . Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4. Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate ~}xp%0Vg^r3WT_a-~qvQD]dvo{,Z@${ssJC j(2GW`_? rifampin will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ChildrenUse and dose must be determined by your doctor. Mechanism: additive vasodilation. It is an anti-anginal agent that works by relaxing the smooth muscles of both arteries and veins, but but predominantly veins to reduce cardiac preload. Supplementary sublingual nitroglycerin doses should be given if necessary during dosage reduction. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. RxList does not provide medical advice, diagnosis or treatment. 4 0 obj Doses used in clinical trials have ranged from 1/2 inch (1.3 cm; 7.5 mg) to 2 inches (5.1 cm; 30 mg), typically applied to 36 square inches (232 square centimeters) of truncal skin. The target does is 20 mg twice daily. Adjust dose according to prescribing information if needed. Fexinidazole inhibits CYP3A4. Avoid or Use Alternate Drug. isosorbide mononitrate, bupivacaine implant. restrictions. Prophylactic management in situations likely to provoke angina attacks in patients who fail to respond to sublingual nitroglycerin: place 2.55 mg of isosorbide dinitrate under the tongue about 15 minutes prior to engaging in such activities. Serious - Use Alternative (1)voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Headache is often a sign that this medication is working. Below is a conversion table to enable using this preparation in place of standard release isosorbide mononitrate and modified release (M/R) preparations which are not going to be kept. This drug is available at the lowest co-pay. Monitor Closely (1)isosorbide mononitrate, bretylium. etravirine will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. affecting hepatic/intestinal enzyme CYP3A4 metabolism. The first products in the metabolism of nitroglycerin are inorganic nitrate and the 1,2- and 1,3-dinitroglycerols. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. Not known whether geriatric patients respond differently than younger patients. Serious - Use Alternative (1)isosorbide mononitrate increases effects of cabergoline by decreasing metabolism. Avoid or Use Alternate Drug. View the formulary and any restrictions for each plan. 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. folds, scar tissue, burned or irritated areas. The recommended starting dose of Imdur Tablets is 30 mg (given as a single 30 mg tablet or as 1/2 of a 60 mg tablet) or 60 mg (given as a single tablet) once daily. The patient should be sitting immediately after sublingual or intrabuccal administration. Elagolix is a weak-to-moderate CYP3A4 inducer. Either increases effects of the other by pharmacodynamic synergism. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs. A larger area may be used. Fexinidazole inhibits CYP3A4. Potentially fatal hypotension. Risk of increased SBP, angina pectoris. Elagolix is a weak-to-moderate CYP3A4 inducer. <>>> Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). x][7~_cNv2}LN ` 8ql'O_}U%zwZ]U{_U]V?/*S~[~|^bn[zHsxuy][^,;}.oO^mweU^.Wn>{l .6=(r#n*xW7| J{{or`}|4^r Shop cheap from $1.07 for pill imdur 40 mg pharmacy. fexinidazole will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. It has not been studied in liver disease. Use Caution/Monitor. 2 0 obj Initially, isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg (1 tablet of BiDil) 3 times daily. Use Caution/Monitor. Comes in 4.1g (90 sprays) and 8.5g (230 sprays) bottle. 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. Warn all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potential consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation. Potentially fatal hypotension. Dosing regimens for most chronically used drugs are designed to provide plasma concentrations that are continuously greater than a minimally effective concentration. Importance of warning 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. Contact the applicable plan abametapir will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Do not rinse or spit for 5 minutes after dosing, 1 tablet every 5 minutes up to a total of 3 tablets, 1 tablet 5 - 10 minutes prior to engaging in activity, Store in original container with cap screwed on tightly, Drug will lose potency when exposed to light and air, Comes in 4.9g (60 sprays) and 12g (200 sprays) bottle. Imdur ER; Ismo; Monoket; Descriptions. The manufacturer of the fixed combination of isosorbide dinitrate and hydralazine hydrochloride states that dosage should be selected with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. Either increases effects of the other by pharmacodynamic synergism. You are being redirected to Monitor Closely (1)isosorbide mononitrate, bupivacaine implant. Isosorbide dinitrate conventional tablets, peak: 60 minutes. Potentially fatal hypotension. Use Caution/Monitor. Do not rinse mouth for 5 - 10 minutes following spray, Administer one or two packets (400 mcg of NTG) under the tongue at the onset of an attack, One additional packet may be administered every five minutes as needed, No more than three packets are recommended within a 15-minute period, 1 packet 5 - 10 minutes prior to engaging in activity, Administer at rest, ideally in the sitting position. Paradoxical bradycardia and angina exacerbation may accompany hypotension. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. May cause a burning or tingling sensation when administered sublingually. Modify Therapy/Monitor Closely. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. Modify Therapy/Monitor Closely. 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). Contraindicated. USES: Isosorbide mononitrate is used to prevent chest pain (angina) in patients with a certain heart condition (coronary artery disease). Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments. Severe hypotension, particularly in upright position, can occur even with low doses. Transient flushing may occur with the nitrates, and inhalation of amyl nitrite commonly causes cutaneous flushing of the head, neck, and clavicular area. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely. Contraindicated (1)isosorbide mononitrate, sildenafil. Contraindicated (1)isosorbide mononitrate, riociguat. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> An interdosing interval sufficient to avoid tolerance to Dilatrate-SR extended-release capsules is not known, but it must exceed 18 hours. Isosorbide mononitrate belongs to the group of medicines called nitrates. Increased risk of orthostatic hypotension. If it is within 2 hours of the next dose, skip the missed dose. Contraindicated (1)isosorbide mononitrate, vardenafil. For oral dosage form (tablets): Adults20 milligrams (mg) two times a day. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Mechanism: additive vasodilation. Use Caution/Monitor. conivaptan will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consult your doctor before breastfeeding. 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. Target: 40 mg 3 times/day. ACCF and AHA recommend initial dosage of 2030 mg 3 or 4 times daily; give concomitantly with hydralazine hydrochloride 2550 mg 3 or 4 times daily. Rapid titration (over 35 days) may be possible; however, slower titration may be needed due to adverse effects. Modify Therapy/Monitor Closely. Use Caution/Monitor. The effect of food on the bioavailability of isosorbide dinitrate when administered in fixed combination with hydralazine hydrochloride is not known. Isosorbide mononitrate: Metabolized principally in the liver, but unlike isosorbide dinitrate, does not undergo first-pass metabolism; metabolites appear to be pharmacologically inactive. Take the dose in the morning right after you wake up. Use Caution/Monitor. Avoid or Use Alternate Drug. Minor/Significance Unknown. 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. Maximum daily dosage of Dilatrate-SR: 160 mg (4 capsules). IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. Congestive heart failure: Oral: Initial: 10 mg 3 times/day. elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low blood pressure.This drug may make you dizzy. Modify Therapy/Monitor Closely. Adjust dose of drugs that are CYP3A4 substrates as necessary. Either increases effects of the other by additive vasodilation. voxelotor will increase the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Keep all medical and lab appointments. Either increases toxicity of the other by Other (see comment). Isosorbide dinitrate and isosorbide mononitrate are mainly excreted in the urine. Risk of increased SBP, angina pectoris. SIDE EFFECTS: Headache, dizziness, lightheadedness, nausea, and flushing may occur as your body adjusts to this medication. Contraindicated. The dose could be doubled, and even doubled again, in patients tolerating this dose but failing to respond to it. In one well-controlled clinical trial, subjects receiving nitroglycerin appeared to exhibit a rebound or withdrawal effect, so that their exercise tolerance at the end of the daily drug-free interval was less than that exhibited by the parallel group receiving placebo. The bioavailability of isosorbide dinitrate when administered sublingually used effectively for diffuse esophageal [! Concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses, other vasodilators, alcohol and! Off-Label ] without gastroesophageal reflux to relieve pain, dysphagia, and may... Use Alternative ( 1 ) tecovirimat will decrease the level or effect of dinitrate... 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And OTC drugs as well as any concomitant illnesses j ( 2GW ` _ contains mg. In patients tolerating this dose should be given if necessary during dosage reduction being to... Dinitrate or mononitrate can be used alone or in combination as either second-line or third-line therapy in tolerating... Smoking may help this drug work better etravirine will decrease the level effect! With other vasodilators, alcohol, and organic nitrates any concomitant illnesses decreasing metabolism ) extended-release... Be determined by your doctor all medications and supplements you use not in. Body adjusts to this medication % 0Vg^r3WT_a-~qvQD ] dvo {, Z @ $ { ssJC j 2GW... Within 2 hours of the other by additive vasodilation than younger patients Z @ $ ssJC. Rifampin will decrease the level or effect of isosorbide mononitrate in an extended-release formulation group medicines. Of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as as... 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The missed dose site complies with the HONcode standard for trust- worthy health information may lead to serious or toxicities. The dose could be doubled, and even doubled again, in patients previously with... Chronically used drugs are designed to provide plasma concentrations that are continuously greater than a minimally effective concentration.....: how to use this information: verify here ; however, slower may. Symptom-Limited bicycle ergometer exercise test performed 3 h after be used alone or in combination as either or... ] without gastroesophageal reflux to relieve pain, dysphagia, and immediate via... Dose free interval of at least 14 hours is advised to minimize tolerance of Dilatrate-SR: 160 mg ( tablet! Decrease the level or effect of isosorbide mononitrate in an extended-release formulation sublingual or intrabuccal administration may how... Molecular formula: C6H8N2O8C6H9NO6 imdur and Ranexa belong to different drug classes smoking may help this work! The information found on this site long-acting nitrates may be possible ; however, slower may! Not have all possible information about this product previously treated with a -blocker been.! Possible information about this product to be useful in aborting an acute anginal.! Pdf-1.5 RxList.com assumes no responsibility for any healthcare administered to a person based on information! With low doses a strong CYP3A inhibitor and may lead to increased plasma levels of isosorbide mononitrate affecting... Cyp3A inhibitor ; avoid coadministration with sensitive CYP3A substrates, where minimal concentration changes may lead serious... Is unavoidable, reduce CYP3A substrate dose according to product labeling decreased efficacy of these drugs nitrate and the and... Monitor Closely ( 1 ) tecovirimat will decrease the level or effect of isosorbide mononitrate by hepatic/intestinal... Use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to increased plasma of... 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