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Avoid use in hypertrophic cardiomyopathy with outflow tract obstruction. Nitrates may reduce preload, exacerbating obstruction and cause hypotension or syncope and/or worsening of heart failure.
Not recommended for use in patients with acute myocardial infarction or heart failure (has not been studied).
Avoid use in patients who marked bradycardia or tachycardia, and right ventricular MI. Because the effects of Isosorbide-5-mononitrate are so difficult to terminate rapidly, this product is not recommended in these settings.
Since a rebound phenomenon cannot be excluded, therapy with Isosorbide-5-mononitrate should be terminated gradually rather than stopping abruptly.
Severe hypotension can occur, paradoxical bradycardia and increased angina pectoris can accompany hypotension.
Severe postural hypotension with light-headedness and dizziness is frequently observed after the consumption of alcohol.
Tolerance development and occurrence of cross-tolerance with other nitrate compounds have been described. In order to avoid any attenuation or loss of effect, high continuous dosing regimens should be avoided.
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