What is this medication?
Isosorbide mononitrate (Sublingual), Imdur/ISMN
Antianginal Agent; Vasodilator
Isosorbide mononitrate is indicated for treatment of angina pectoris
How does this medication work?
Isosorbide mononitrate, Imdur/ISMN forms free radical nitric oxide which increases cGMP which dephosphorylates myosin light chains in smooth muscle resulting in their relaxation. This results in vasodilation of peripheral veins and arteries with more effect on the veins. Reduces oxygen demand of heart by decreasing the preload and modestly reducing afterload of left ventricle. It also increased blood flow to ischemic areas of heart via action of coronary arteries.
How should I take this medication?
Immediate release: 20 mg twice daily with the 2 doses given 7 hours apart (eg, 8 AM and 3 PM) to decrease tolerance development; patients with small stature may initiate therapy with 5 mg twice daily and titrate to at least 10 mg twice daily in first 2 to 3 days of therapy.
Extended release: Initial: 30 to 60 mg once daily in the morning; may titrate after several days to 120 mg once daily; rarely, 240 mg once daily may be required
How to Take: Tolerance to nitrate effects develops with chronic exposure. Dose escalation does not overcome this effect. Tolerance can only be overcome by short periods of nitrate absence from the body. Recommended twice daily dosage regimens incorporate this interval. Short periods of nitrate withdrawal may help minimize tolerance IR tablet should be scheduled twice daily with doses 7 hours apart (8 AM and 3 PM). Administer ER tablet once daily in the morning upon rising with a half-glassful of fluid. Empty matrix “ghosts” (tablets) may pass in patients via colostomy or in the stool which is normal.
You Need to Avoid: Do not administer around-the-clock. Do not chew or crush ER tablets; may be divided in half.
What should I watch for while using this medication?
Before starting Isosorbide mononitrate, Imdur/ISMN make sure your physician is aware of any allergies, medications (medications that can be used for erectile dysfunction especially) you currently take, if you have other cardiovascular disease, hypertrophic cardiomyopathy, if you are pregnant, or breastfeeding. Isosorbide mononitrate, Imdur/ISMN use has been associated with rare but potentially serious adverse events such as CNS depression, hypotension, bradycardia, and increases in intracranial pressure.
What if I miss a dose?
If you miss a dose of medication, try to take it as soon as possible. However, if it is almost time for your next dose, take only that scheduled dose. Do not take double or extra doses.
How should I store this medication?
Keep out of the reach of children at all times. Store at room temperature, 59 to 86° F (15 to 30° C). Protect from light. Keep the container tightly closed. Properly dispose of any unused medication after the expiration date.
What are the possible side effects of using this medication?
Headache, hypotension, syncope (fainting), dizziness
Note this is not a complete list of side effects.
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