Isosorbide Mononitrate 60mg

Isosorbide mononitrate (Sublingual), Imdur/ISMN
Description: Antianginal Agent; Vasodilator

CSA NA – FDA Approved – REMS (N) – Can Ship

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.

Angina pectoris

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.

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.

Headache, hypotension, syncope (fainting), dizziness

Note this is not a complete list of side effects.

1. What is the issue with using erectile dysfunction medication with this?
   Mixing this medication with PDE-5 inhibitors (sildenafil/Viagra, tadalafil/Cialis etc.) which are generally used for erectile dysfunction can result in extremely dangerous drops in blood pressure which could result in loss of perfusion of organs and result in death.  There is no exact interval that has been established for safe use of both medications concurrently so the combination should be avoided.