Adult: As prophylaxis and treatment of cases due to coronary artery disease: As immediate-release tab: 20 mg bid or tid. Usual dosing range: 20-120 mg daily. As prophylaxis: As prolonged-release tab or cap: Initially, 25-60 mg once daily (preferably in the morning); may increase to 120 mg once daily. Dosing and treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
Oral Congestive heart failure
Adult: As adjunctive therapy in cases not responding to cardiac glycosides or diuretics: As immediate-release tab: 20 mg bid or tid. Usual dosing range: 20-120 mg daily. Treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
What are the brands available for Isosorbide mononitrate in Philippines?
Isosorbide mononitrate Should be taken on an empty stomach.
Contraindications
Acute MI with low filling pressures, acute circulatory failure (e.g. shock, vascular collapse), severe hypotension, hypertrophic obstructive cardiomyopathy (HOCM), constrictive pericarditis, cardiac tamponade, low cardiac filling pressures, aortic or mitral valve stenosis, diseases associated with increased intracranial pressure (e.g. head trauma, cerebral haemorrhage), marked anaemia, closed angle glaucoma, hypovolaemia. Concomitant use with phosphodiesterase type-5 inhibitors (e.g. sildenafil, tadalafil, vardenafil) or riociguat.
Special Precautions
Patient with recent history of MI; hypothyroidism, hypothermia, malnutrition; hypoxaemia and ventilation or perfusion imbalance due to lung disease or ischaemic heart failure. Not indicated for immediate relief of acute anginal attacks. Avoid abrupt withdrawal. Severe renal and liver impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Headache, migraine or cluster headache; postural or orthostatic hypotension, syncope; hypotension accompanied by paradoxical bradycardia and increased angina; precipitate or aggravate increased intracranial pressure. Cardiac disorders: Tachycardia. Gastrointestinal disorders: Nausea, vomiting. General disorders and administration site conditions: Asthenia. Nervous system disorders: Dizziness, somnolence. Skin and subcutaneous tissue disorders: Rash. Vascular disorders: Flushing.
This drug may cause drowsiness, tiredness or blurred vision, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor blood pressure and heart rate.
Overdosage
Symptoms: Headache, hypotension, nausea, vomiting, sweating, tachycardia, vertigo, restlessness, warm flushed skin, blurred vision, syncope; increased intracranial pressure with confusion and neurological deficits; methaemoglobinaemia (manifested as cyanosis, hypoxaemia, restlessness, respiratory depression, convulsions, cardiac arrhythmias, circulatory failure, raised intracranial pressure). Management: Symptomatic and supportive treatment. Administer activated charcoal if ingestion occurred within 1 hour; monitor patient for at least 12 hours post-ingestion. Monitor blood pressure and pulse rate. Raise the foot of the bed and/or expand intravascular volume to correct hypotension. Consider giving inotropes if severe hypotension persists. Give IV methylthioninium chloride (1-2 mg/kg), RBC concentrates or exchange infusion for methaemoglobinaemia. Administer diazepam or clonazepam IV, phenobarbital, phenytoin or propofol anaesthesia for cerebral convulsion.
Drug Interactions
Concomitant use with blood pressure lowering drugs (e.g. β-blockers, calcium channel blockers, vasodilators, alprostadil, aldesleukin, ACE inhibitors, ARBs), neuroleptics or TCAs may potentiate hypotensive effects. May increase the plasma concentration of dihydroergotamine. Potentially Fatal: Increased risk of severe hypotension, syncope or MI with phosphodiesterase type-5 inhibitors (e.g. sildenafil, tadalafil, vardenafil). Increased risk of hypotension with riociguat.
Food Interaction
Increased risk of dizziness, tiredness and blurred vision with alcohol.
Action
Description: Mechanism of Action: Isosorbide mononitrate is the major active metabolite of isosorbide dinitrate. It forms free radical nitric oxide which activates guanyl cyclase, thereby increasing guanosine 3’5’ monophosphate (cGMP). This results in dephosphorylation of myosin light chains and smooth muscle relaxation. Furthermore, it produces vasodilator effect on the peripheral veins and arteries. This promotes pooling of the blood in the periphery leading to decreased venous return to the heart, thereby decreasing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Additionally, it reduces afterload, dilates coronary arteries and improves collateral flow to ischaemic regions. Onset: 30-45 minutes. Duration: ≥6 hours (immediate-release); ≥12-24 hours (extended-release). Pharmacokinetics: Absorption: Rapidly and completely absorbed from the gastrointestinal tract. Bioavailability: Approx 100%. Time to peak plasma concentration: 30-60 minutes. Distribution: Widely distributed. Volume of distribution: Approx 0.6 L/kg. Plasma protein binding: <5%. Metabolism: Metabolised in the liver into inactive metabolites. Excretion: Mainly via urine (2% as unchanged drug); faeces (1%). Elimination half-life: 5-6 hours.
Chemical Structure
Isosorbide mononitrate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 27661, Isosorbide Mononitrate. https://pubchem.ncbi.nlm.nih.gov/compound/Isosorbide-Mononitrate. Accessed July 28, 2025.
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