Nitrate drugs – isosorbide 5 mononitrate extended release

Last updated on October 6, 2022

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Generic name		isosorbide 5 mononitrate extended release
Strength		60 mg
Form		tablet

Criteria	Approval period
1. Treatment failure on optimal dose of, or intolerance to, isosorbide dinitrate (ISDN). OR 2. Person identified as having unstable angina.	Indefinite

Criteria

Approval period

1. Treatment failure on optimal dose of, or intolerance to, isosorbide dinitrate (ISDN).

2. Person identified as having unstable angina.

Indefinite

Practitioner exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

Paediatric Cardiology
Paediatrics
Paediatric General Surgery

Special notes

None

Special Authority request form(s)

Log in to eForms
5328—General Special Authority Request

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Nitrate drugs – isosorbide 5 mononitrate extended release

Practitioner exemptions

Special notes

Special Authority request form(s)