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Isosorbide Mononitrate: Brands, Price & Uses in Bangladesh
Established (FDA-approved) Use Isosorbide Mononitrate is indicated for the prevention of angina pectoris due to coronary artery disease.
About Isosorbide Mononitrate
Indications of Isosorbide Mononitrate
Established (FDA-approved) Use
Isosorbide Mononitrate is indicated for the prevention of angina pectoris due to coronary artery disease. It is used for long-term prophylaxis of exertional angina and is intended to reduce the frequency of anginal attacks with regular, scheduled dosing.
Important Limitation of Use
Isosorbide Mononitrate is not intended to abort an acute anginal attack because its onset of action is too slow for that purpose; a fast-acting sublingual nitrate should be used for acute episodes.
Not Established / Not Recommended
Isosorbide Mononitrate is not approved for acute coronary syndromes, acute myocardial infarction, or acute decompensated heart failure, and should not be relied upon for these indications.
Dosage & Administration of Isosorbide Mononitrate
Dosage by Formulation (Angina Prophylaxis)
| Formulation | Adult Dose | Notes |
|---|---|---|
| Immediate-release tablet | Initially 5-20 mg twice daily, with the two doses given 7 hours apart (e.g., on waking and 7 hours later); may be titrated to 20 mg twice daily after 2-3 days if needed | Asymmetric schedule maintains a nitrate-free interval to reduce tolerance |
| Extended-release tablet | Initially 30-60 mg once daily in the morning; may be increased at intervals of several days to 120 mg once daily; maximum 240 mg/day (rarely required) | Swallow whole; do not crush, chew, or split |
Pediatric Dose
Safety and efficacy in children have not been established; Isosorbide Mononitrate is not recommended for pediatric use.
Dose Adjustment
No well-established dose adjustment is required for renal impairment. In hepatic impairment, start at the lower end of the dosing range with close monitoring for hypotension, as bioavailability may be increased.
Side Effects of Isosorbide Mononitrate
Very common: Headache is very common when starting Isosorbide Mononitrate, particularly at the beginning of therapy; it often diminishes with continued regular use and may respond to a mild analgesic.
Common: Dizziness, lightheadedness, flushing, orthostatic (postural) hypotension, reflex tachycardia, nausea.
Less common/rare: Syncope (fainting), especially after the first few doses or with dose increases; rash; and, rarely with very high doses, methemoglobinemia.
Contraindications of Isosorbide Mononitrate
- Known hypersensitivity to Isosorbide Mononitrate or any other organic nitrate.
- Concurrent use with PDE5 inhibitors (sildenafil, tadalafil, vardenafil) due to risk of severe/life-threatening hypotension.
- Concurrent use with riociguat.
- Severe hypotension or uncorrected hypovolemia.
- Severe anemia.
- Angle-closure (closed-angle) glaucoma.
- Hypertrophic obstructive cardiomyopathy.
- Right ventricular infarction (a preload-dependent state that nitrates can worsen).
Frequently Asked Questions about Isosorbide Mononitrate
What is Isosorbide Mononitrate used for?
Isosorbide Mononitrate is used to prevent episodes of angina (chest pain) in people with coronary artery disease. It is taken on a regular schedule to reduce how often angina occurs; it is not used to treat an angina attack that has already started.
Can I take Isosorbide Mononitrate if I use sildenafil, tadalafil, or vardenafil?
No. Isosorbide Mononitrate must never be combined with PDE5 inhibitors such as sildenafil, tadalafil, or vardenafil, or with riociguat, because this combination can cause severe, potentially life-threatening drops in blood pressure. Tell your doctor about all medicines you take, including those for erectile dysfunction or pulmonary hypertension.
Why do I need to take my two daily doses 7 hours apart instead of evenly spaced?
Isosorbide Mononitrate loses effectiveness (develops tolerance) if blood levels stay high all day. Taking the two immediate-release doses about 7 hours apart leaves a nitrate-free interval, usually overnight, which helps Isosorbide Mononitrate keep working.
Is it safe to stop Isosorbide Mononitrate suddenly?
Stopping Isosorbide Mononitrate abruptly after long-term, high-dose use may trigger rebound angina. If your doctor advises stopping long-term high-dose therapy, the dose should be reduced gradually rather than stopped all at once.
What is the most common side effect of Isosorbide Mononitrate?
Headache is very common, especially when starting Isosorbide Mononitrate. It usually becomes less noticeable with continued use; tell your doctor if it is severe or persistent.
Can Isosorbide Mononitrate be used during pregnancy?
Data are limited. Isosorbide Mononitrate should be used in pregnancy only if clearly needed and if the potential benefit outweighs the potential risk to the fetus, and only after consulting a physician.
Disclaimer
The information provided is accurate to the best of our knowledge, but it does not replace professional medical advice. We cannot guarantee its completeness or accuracy, and the absence of specific information about a drug should not be taken as an endorsement. We are not responsible for any consequences arising from this information, so please consult a healthcare professional for any concerns or questions.