Nitrate Drugs - Special Authority Criteria

Generic Name / Strength / Form
isosorbide 5 mononitrate extended release 60mg tablets

Criteria Approval Period
1. Treatment failure or intolerance to isosorbide dinitrate (ISDN).

OR

2. Person identified as having unstable angina.

 Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • None

Online Form (PDF)
Click on the link to complete a special authority request form.