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If you have been taking it regularly and you stop taking it, your angina symptoms or heart failure may get worse. If you are taking isosorbide mononitrate or dinitrate and are bothered by side effects, speak to your doctor. They may be able to change your dose or prescribe a different medicine instead. Drinking alcohol can increase the effects of isosorbide mononitrate and dinitrate. It can make your blood pressure too low and you may feel dizzy, lightheaded or sleepy.
If your heart failure is directly related to drinking alcohol, you may be advised to stop completely. Apart from limiting alcohol, you can eat and drink normally while you are taking isosorbide mononitrate or dinitrate. However, if you have angina you may have a higher risk of having a heart attack or stroke. If you have stable angina the most common type , you'll be given medicine to take when you have an angina attack.
This is called glyceryl trinitrate , or GTN. It comes as a mouth spray or tablets that dissolve under your tongue. Isosorbide mononitrate and dinitrate are not used to treat sudden angina attacks. They work by preventing attacks from happening. If you have angina, to help avoid more attacks you may need to take at least 1 medicine every day for the rest of your life. Some people need to take 2 or more medicines. If you cannot take either of these medicines, you may be given another medicine such as ivabradine, nicorandil or ranolazine.
Your doctor will be the best person to decide what treatment is best for you. Tell your doctor that you're taking isosorbide mononitrate or dinitrate if you're going to be put to sleep using general anaesthesia , or you're having any kind of major operation.
Your doctor may advise you to stop taking isosorbide mononitrate or dinitrate before surgery. This is because it can lower your blood pressure too much when combined with some anaesthetics.
Isosorbide mononitrate and dinitrate will not stop your contraception working, including emergency contraception.
However, if you have angina, oral contraceptives such as the combined pill are not recommended because they increase the risk of heart attack and stroke. Talk to your doctor if you're taking a combined hormonal contraceptive.
There is no clear evidence that isosorbide mononitrate or dinitrate affects fertility in men or women. Isosorbide mononitrate or dinitrate is not likely to affect your sex life. However, do not take medicines for erection problems if you are taking isosorbide mononitrate or dinitrate. These include:. Some people with angina worry that having sex will trigger an angina attack, but the risk of this happening is low. It is as safe as other forms of exercise with similar levels of effort.
You do not need to avoid playing sports due to taking isosorbide mononitrate or dinitrate. Talk to your doctor if you're not sure it's safe for you to exercise. Isosorbide mononitrate and dinitrate can make some people feel dizzy, sleepy or faint. If this happens to you, do not drive, ride a bike or use tools or operate machinery until you feel better. Angina and heart failure is a warning sign that you are at risk of serious problems such as heart attacks and strokes.
Page last reviewed: 1 July Next review due: 1 July Isosorbide mononitrate and isosorbide dinitrate - Brand names: Chemydur, Isotard, Monomil Elantan LA, Isoket Retard On this page About isosorbide mononitrate and isosorbide dinitrate Key facts Who can and cannot take isosorbide mononitrate and isosorbide dinitrate How and when to take isosorbide mononitrate and isosorbide dinitrate Side effects How to cope with side effects of isosorbide mononitrate and isosorbide dinitrate Pregnancy and breastfeeding Cautions with other medicines Common questions about isosorbide mononitrate and isosorbide dinitrate.
About isosorbide mononitrate and isosorbide dinitrate Isosorbide mononitrate and dinitrate are types of heart medicine called nitrates. Both isosorbide mononitrate and isosorbide dinitrate are broken down into nitrates in the body.
Nitrates work by widening blood vessels veins and arteries. This increases the blood supply to your heart, which gets more oxygen to your heart muscles. This helps your heart to work properly and reduces chest pain. The tablets and capsules usually start to work within 1 hour. The most common side effects are headaches and feeling dizzy, weak or tired. If you stop taking isosorbide mononitrate or isosorbide dinitrate, your symptoms may get worse.
Isosorbide dinitrate regular and extended-release tablets are used to prevent angina attacks but will not treat an angina attack. Taking these medicines together can cause a sudden and serious decrease in blood pressure. It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether isosorbide dinitrate passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding.
Before using isosorbide dinitrate to treat a sudden angina attack, your doctor may want you to first use a nitroglycerin sublingual tablet. Follow your doctor's instructions about what medications to use during an attack and how much time to allow between doses. Follow all directions on your prescription label. Your doctor may occasionally change your dose. Do not take this medicine in larger or smaller amounts or for longer than recommended.
If you use too much isosorbide dinitrate, it might stop working as well in controlling your condition. To prevent angina attacks, isosorbide dinitrate is usually taken at regular intervals. To treat an angina attack that has already begun, use the medicine at the first sign of chest pain.
Place the tablet under your tongue and allow it to dissolve slowly. Do not chew or swallow it. You may use the sublingual tablet within 15 minutes before an activity you think might cause chest pain. Follow your doctor's instructions. Do not crush, chew, break, or open an extended-release capsule or tablet. Swallow it whole. Follow your doctor's dosing instructions very carefully. If your doctor changes your brand, strength, or type of isosorbide dinitrate, your dosage needs may change.
Ask your pharmacist if you have any questions about the new kind of isosorbide dinitrate you receive at the pharmacy. Seek emergency medical attention if your chest pain gets worse or lasts longer than 5 minutes, especially if you have trouble breathing or feel weak, dizzy, or nauseated, or lightheaded. You may have very low blood pressure while taking this medicine.
Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. Prolonged illness can lead to a serious electrolyte imbalance, making it dangerous for you to use isosorbide dinitrate.
If you take isosorbide dinitrate on a regular schedule to prevent angina , do not stop taking it suddenly or you could have a severe attack of angina. Keep this medicine on hand at all times. Get your prescription refilled before you run out of medicine completely. It must be remembered that nitrates potentiate the action of other vasodilators and calcium channel blockers and that, in some patients, intravenous nitroglycerin reduces the anticoagulant effect of heparin, while indomethacin can inhibit their vasodilator effect.
Nitrates are therefore in very good health despite their advanced age and, when used correctly, they continue to be very useful in the pharmacological treatment of cardiovascular diseases. Abstract Nitrates, which have been used for more than a century, are the second oldest drug after digitalis alkaloids in the cardiological pharmacological arsenal.
Publication types English Abstract Review. As with other nitrates, daily headaches sometimes accompany treatment with ISMN. In patients who get these headaches, the headaches are a marker of the activity of the drug.
Patients should resist the temptation to avoid headaches by altering the schedule of their treatment with ISMN, since loss of headache may be associated with simultaneous loss of antianginal efficacy.
Treatment with ISMN may be associated with light-headedness on standing, especially just after rising from a recumbent or seated position. This effect may be more frequent in patients who have also consumed alcohol. Patients should be advised that they may pass empty matrix "ghosts" tablets via colostomy or in the stool, and that this is of no concern since the active medication has already been absorbed. The vasodilating effects of ISMN may be additive with those of other vasodilators.
Alcohol, in particular, has been found to exhibit additive effects of this variety. Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. Nitrates and nitrites may interfere with the Zlatkis-Zak color reaction, causing falsely low readings in serum cholesterol determinations.
ISMN did not produce gene mutations Ames test, mouse lymphoma test or chromosome aberrations human lymphocyte and mouse micronucleus tests at biologically relevant concentrations. Pregnancy category B. These animal doses are about times the maximum recommended human dose mg in a 50 kg woman when comparison is based on body weight; when comparison is based on body surface area, the rat dose is about 17 times the human dose and the rabbit dose is about 38 times the human dose.
There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, Isosorbide mononitrate extended-release tablets should be used during pregnancy only if clearly needed. This dose about times the human dose when comparison is based on body weight and 54 times the human dose when comparison is based on body surface area was associated with decreases in maternal weight gain and motor activity and evidence of impaired lactation.
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when ISMN is administered to a nursing mother.
The safety and effectiveness of ISMN in pediatric patients have not been established. Clinical studies of Isosorbide Mononitrate Extended-release Tablets did not include sufficient information on patients age 65 and over to determine whether they respond differently from younger patients. Other reported clinical experience for Isosorbide Mononitrate Extended-release tablets has not identified differences in response between elderly and younger patients. Clinical experience for organic nitrates reported in the literature identified a potential for severe hypotension and increased sensitivity to nitrates in the elderly.
In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the doing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of the concomitant disease or other drug therapy.
Elderly patients may have reduced baroreceptor function and may develop severe orthostatic hypotension when vasodilators are used. Isosorbide Mononitrate Extended-release Tablets should therefore be used with caution in elderly patients who may be volume depleted, on multiple medications or who, for whatever reason, are already hypotensive.
Hypotension induced by isosorbide mononitrate may be accompanied by paradoxical bradycardia and increased angina pectoris. Elderly patients may be more susceptible to hypotension and may be at greater risk of falling at therapeutic doses of nitroglycerin.
Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy, particularly in the elderly. In parentheses, the same table shows the frequencies with which these adverse events were associated with the discontinuation of treatment. Most of these discontinued because of headache. Dizziness was rarely associated with withdrawal from these studies. Since headache appears to be a dose-related adverse effect and tends to disappear with continued treatment, it is recommended that Isosorbide mononitrate extended-release tablets treatment be initiated at low doses for several days before being increased to desired levels.
In addition, the three North American trials were pooled with 11 controlled trials conducted in Europe. Among the 14 controlled trials, a total of patients were randomized to Isosorbide mononitrate extended-release tablets. Body As A Whole : Asthenia, back pain, chest pain, edema, fatigue, fever, flu-like symptoms, malaise, rigors. Cardiovascular Disorders, General : Cardiac failure, hypertension, hypotension. Central And Peripheral Nervous System Disorders : Dizziness, headache, hypoesthesia, migraine, neuritis, paresis, paresthesia, ptosis, tremor, vertigo.
Gastrointestinal System Disorders : Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, gastric ulcer, gastritis, glossitis, hemorrhagic gastric ulcer, hemorrhoids, loose stools, melena, nausea, vomiting.
Hearing And Vestibular Disorders : Earache, tinnitus, tympanic membrane perforation. Heart Rate and Rhythm Disorders : Arrhythmia, arrhythmia atrial, atrial fibrillation, bradycardia, bundle branch block, extrasystole, palpitation, tachycardia, ventricular tachycardia.
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