Ismox (Isosorbide 5 Mononitrate)

Isosorbide 5 Mononitrate is employed in the treatment of coronary artery disease and related anginal conditions.

• Stable angina: reduces the frequency and severity of chest pain episodes.
• Chronic coronary syndrome: improves exercise tolerance and myocardial oxygen supply.
• Angina prophylaxis: prevents recurrence of angina attacks in patients with known coronary disease.

• Isosorbide 5 Mononitrate is metabolized to release nitric oxide, which activates guanylate cyclase in vascular smooth muscle. The resulting increase in cyclic GMP leads to relaxation of arterial and venous vessels, lowering preload and afterload, and thereby enhancing myocardial oxygen delivery while reducing cardiac workload.

Isosorbide 5 Mononitrate may cause a range of adverse reactions.

Common Side Effects

• Headache: throbbing pain often occurring shortly after dosing.
• Dizziness or light‑headedness: related to blood pressure reduction.
• Flushing: warm sensation and reddening of the skin.
• Nausea: mild gastrointestinal upset.
• Palpitations: awareness of heartbeat acceleration.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Syncope: transient loss of consciousness due to inadequate cerebral perfusion.
• Allergic reactions: rash, itching, or swelling that may progress to anaphylaxis.
• Stevens‑Johnson syndrome: rare severe skin reaction.
• Myocardial infarction: extremely rare but reported in susceptible individuals.

Before initiating therapy, clinicians should consider several safety measures.

• Assess cardiovascular status: evaluate blood pressure and heart rate.
• Avoid concurrent PDE‑5 inhibitors: risk of profound hypotension.
• Monitor for tolerance development: efficacy may diminish with prolonged use.
• Adjust dose in renal impairment: consider reduced dosing or increased monitoring.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Isosorbide 5 Mononitrate can interact with several medication classes.

Major Interactions (Avoid)

• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): may cause severe hypotension.
• Other nitrates (e.g., nitroglycerin, isosorbide dinitrate): additive vasodilatory effect.
• Alcohol: can potentiate blood‑pressure‑lowering actions.

Moderate Interactions (Monitor Closely)

• Antihypertensives (ACE inhibitors, beta‑blockers): may enhance blood pressure reduction.
• Diuretics: may lead to electrolyte disturbances and further hypotension.
• Azole antifungals (e.g., ketoconazole): may increase plasma concentrations of the nitrate.