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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
Online Form (PDF)
Click on the link to complete a special authority request form.
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Last Revised: June 21, 2006
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