Isosorbide Mononitraat Retard Viatris (Isosorbide Mononitrate)

Isosorbide Mononitrate is an organic nitrate used in the management of coronary artery disease.

• Angina pectoris: reduces the frequency and severity of chest pain episodes by improving myocardial oxygen supply.
• Chronic stable angina: enhances exercise tolerance and delays the onset of anginal symptoms.
• Angina prophylaxis: provides long‑term prevention of angina attacks in patients with known coronary disease.

• Isosorbide Mononitrate is a prodrug that is metabolized to release nitric oxide. The nitric oxide activates guanylate cyclase, increasing cyclic GMP levels in vascular smooth muscle, which leads to vasodilation. This reduces both preload and afterload, decreasing myocardial oxygen demand and alleviating anginal pain.

Common Side Effects

• Headache: mild to moderate, often transient.
• Dizziness or light‑headedness: related to blood pressure changes.
• Flushing: warm sensation, especially after the first dose.
• Nausea: occasional gastrointestinal upset.
• Hypotension: mild reduction in blood pressure.
• Palpitations: awareness of heartbeat.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Syncope: fainting episodes due to sudden hypotension.
• Allergic reaction: rash, itching, or swelling.
• Chest pain worsening: rare paradoxical increase in angina.
• Arrhythmias: irregular heart rhythms in susceptible individuals.

Before initiating therapy, consider patient‑specific factors and monitor for adverse reactions.

• Assess cardiovascular status: evaluate blood pressure and heart rate.
• Review concomitant nitrate use: avoid additive vasodilation.
• Caution in hepatic impairment: dose adjustment may be required.
• Monitor for hypotension: especially in the elderly or those on antihypertensives.
• Educate on orthostatic changes: advise rising slowly from sitting or lying positions.
• Store at ambient temperature below 25°C: keep in the original pack, protect from moisture and light.

Isosorbide Mononitrate can interact with several drug classes, requiring careful management.

Major Interactions (Avoid)

• Other nitrates (e.g., nitroglycerin): risk of severe hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): additive blood pressure lowering.
• Antihypertensive agents: may potentiate hypotensive effect.

Moderate Interactions (Monitor Closely)

• Diuretics: monitor electrolytes and blood pressure.
• Beta‑blockers: may mask tachycardia signs.
• Alcohol: can enhance hypotensive response.