Indication & Dosage

Oral
Management of angina; Heart failure
Adult: 20 mg 2-3 times daily. Dose may range from 20-120 mg daily.
Elderly: Intiate at lower doses.

Administration Should be taken on an empty stomach (i.e. At least one hour before food or two hours after
food).
Overdosage Symptoms: Increased intracranial pressure, with or without persistent throbbing headache,
confusion and moderate fever, vertigo, palpitations, visual disturbances, nausea and
vomiting.
Contraindications Severe hypotension or anaemia, hypovolaemia, heart failure due to obstruction, or raised
intracranial pressure due to head trauma or cerebral haemorrhage.
Special Precautions Severe renal or severe hepatic impairment, hypothyroidism, malnutrition, or hypothermia.
Caution in patients who are already hypotensive. May aggravate angina caused by
hypertrophic cardiomyopathy. Tolerance may develop after long-term treatment. Lactation.
Adverse Drug Hypotension, tachycardia, flushing, headache, dizziness, palpitation, syncope, confusion.
Reactions Nausea, vomiting, abdominal pain. Restlessness, weakness and vertigo. Dry mouth, chest
pain, back pain, oedema, fatigue, abdominal pain, constipation, diarrhoea, dyspepsia and
flatulence.
Potentially Fatal: Severe hypotension and cardiac failure.

Drug Interactions Hypotensive effects may be increased when used with alcohol or vasodilators. Concurrent
use with calcium channel blockers may lead to marked orthostatic hypotension.
Potentially Fatal: Significant hypotension may occur when used with phosphodiesterase-5
inhibitors.
Lab Interference False decrease in serum cholesterol.
Pregnancy Category
(US FDA)
Category C: Either studies in animals have revealed adverse effects on the foetus
(teratogenic or embryocidal or other) and there are no controlled studies in women or studies
in women and animals are not available. Drugs should be given only if the potential benefit
justifies the potential risk to the foetus.
Storage Oral: Store at 20-25C.

Mechanism of Action Isosorbide mononitrate relaxes vascular smooth muscles by stimulating cyclic-GMP. It
decreases left ventricular pressure (preload) and arterial resistance (afterload).
Onset: 20 min (oral as conventional tab).
Duration: 8-10 hr (oral as conventional tab).
Absorption: Readily absorbed from the GIT (oral); peak plasma concentrations after 1 hr.
Distribution: Widely distributed: Smooth muscle cells of the blood vessels.
Metabolism: Converted to inactive metabolites including isosorbide and isosorbide
glucuronide.
Excretion: Via urine (2% as unchanged); 4-5 hr (elimination half-life).

CIMS Class Anti-Anginal Drugs

ATC Classification C01DA14 - isosorbide mononitrateBelongs to the class of organic nitrate vasodilators. Used
in the treatment of cardiac disease.