Isosorbide Mononitrate

Indications & Dose:

Prophylaxis of angina | Adjunct in congestive heart failure

• BY MOUTH

Adult: Initially 20 mg 2–3 times a day, alternatively initially 40 mg twice daily, increased if necessary up to 120 mg daily in divided doses

Prophylaxis of angina (for patients who have not previously had a nitrate)

Adjunct in congestive heart failure (for patients who have not previously had a nitrate)

• BY MOUTH

Adult: Initially 10 mg twice daily, increased if necessary up to 120 mg daily in divided doses

Children: Not recommended

Contraindications:

 Hypersensitivity to nitrates, severe anemia, closed-angle glaucoma, postural hypotension, head trauma or cerebral hemorrhage (may increase intracranial pressure), acute MI or CHF (mononitrate)

Side Effects:

CNS: Agitation, anxiety, apprehension, confusion, dizziness, dyscoordination, headache, hypoesthesia, hypokinesia, insomnia, nervousness, nightmares, restlessness, vertigo, weakness

CV: Atrial fibrillation, cardiovascular collapse, crescendo angina, dysrhythmias, edema, hypotension (sometimes with paradoxical bradycardia and increased angina), palpitations, postural hypotension, premature ventricular contractions, rebound hypertension, retrosternal discomfort, syncope, tachycardia

EENT: Blurred vision, diplopia

GI: Abdominal pain, diarrhea, dyspepsia, involuntary passing of feces, nausea, tenesmus, vomiting

GU: Dysuria, impotence, involuntary passing of urine, urinary frequency

HEME: Hemolytic anemia, methemoglobinemia

MS: Arthralgia, muscle twitching

SKIN: Cold sweat, crusty skin lesions, exfoliative dermatitis, flushing, pallor, perspiration, pruritus, rash

Cautions:

Precautions:

Acute MI, hypertrophic cardiomyopathy, glaucoma, volume depletion, hypotension, abrupt withdrawal, continuous delivery without nitrate-free interval (tolerance will develop)

PREGNANCY: Excretion into breast milk unknown; use caution in nursing mothers

Interaction:

Drugs

Alcohol: Exaggerated hypotension and cardiac collapse

Calcium channel blockers: Exaggerated symptomatic orthostatic hypotension

Dihydroergotamine: Increases the bioBrands

Available with Cost of dihydroergotamine with resultant increase in mean standing systolic blood pressure: functional antagonism, decreasing effects

Sildenafil: Excessive hypotensive effects

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: