Isosorbide Mononitrate
Cardiac Therapy · Nitrate
Indications
Prophylaxis of angina. Long-term treatment of coronary heart disease. Post treatment of myocardial infarction with persisting anginal symptoms. Long-term treatment of chronic congestive heart failure in combination with digitalis and/or diuretics.
Dosage
Adults: Congestive heart failure: Initially 10 mg daily for 2 days then 10 mg twice daily for 3 days. Maintenance, 20 mg two or three times daily. Max 120 mg daily. Angina prophylaxis: Initially 10 mg daily for 2 days then 10 mg twice daily for 2 days then 10 mg twice daily for three days. Maintenance, 20 mg two or three times daily. Max 120 mg daily. Tab/Cap 40 mg/50 mg/ 60 mg: Angina prophylaxis: One tab or cap daily in the morning, increased if necessary to 2 tab/cap. Children: Not recommended.
Adverse Effects
Postural hypotension, tachycardia (but paradoxical bradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope, temporary hypoxaemia, rash, application site reactions with transdermal patches; very rarely angle-closure glaucoma.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: Hypersensitivity to nitrates, hypotensive conditions and hypovolaemia, hypertrophic cardiomyopathy, aortic stenosis, cardiac tamponade, constrictive pericarditis, mitral stenosis, toxic pulmonary oedema, head trauma, cerebral haemorrhage, cerebrovascular disease, marked anaemia, raised intracranial pressure, extreme bradycardia, closed-angle glaucoma, G6PD deficiency. Precautions: Hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion abnormalities, severe renal or hepatic impairment, orthostatic dysfunction, susceptibility to angle-closure glaucoma; metal-containing transdermal systems should be removed before magnetic resonance imaging procedures, cardioversion, or…
Interactions
Sildenafil, tadalafil, vardenafil, ethanol, heparin, alteplase, ergot alkaloids, PDE5 inhibitors, other nitrates, hypotensive agents, riociguat, apomorphine, sapropterin, alcohol.
Advice to Patient
Take with or without meals as prescribed. Take at same time each day, as prescribed. Chew chewable tablets well and keep them in mouth for 1 to 2 minutes before swallowing. Allow sublingual tablets to dissolve under tongue, do not chew or swallow them. Swallow sustained release capsules whole with a glass of water, do not crush or chew them. If chest pain occurs, seek help immediately. Contact prescriber if there is acute headache, rapid heartbeat, chest pain, unusual restlessness, dizziness, rash, muscular weakness or blurred vision. Do not stop taking medication abruptly, decrease dosage gradually. Avoid alcohol. Carry isosorbide at all times. Change position slowly. Take medication while sitting.
Pharmacokinetics
Onset of action: 30-45 min. Duration: Immediate release: =6 hrs. Extended release: =12-24 hrs. Absorption: Rapid and complete. Metabolism: Hepatic. Bioavailability: Approx. 100%. Half-life elimination: 5-6 hrs. Time to peak, plasma: 30-60 min. Excretion: Urine (predominantly; 2%). Faeces (1%).
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
Always consult a pharmacist or doctor.