Isosorbidemononitraat Aurobindo (Isosorbide Mononitrate)

Isosorbide Mononitrate acts as a nitrate vasodilator to improve myocardial oxygen balance and reduce cardiac workload.

• Angina pectoris: decreases the frequency and severity of chest pain episodes.
• Chronic heart failure (off‑label): may improve exercise tolerance and symptom control.
• Prophylaxis of angina: provides long‑lasting prevention of ischemic attacks in patients with stable coronary disease.

• Isosorbide Mononitrate is a prodrug that is metabolized to release nitric oxide. The nitric oxide activates guanylate cyclase in vascular smooth muscle, increasing cyclic GMP levels, which leads to relaxation of arterial and venous vessels, lowering preload and afterload and improving myocardial oxygen supply‑demand balance.

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Headache: throbbing pain often occurring after the first dose.
• Dizziness: sensation of light‑headedness, especially when standing quickly.
• Flushing: warmth and redness of the face or neck.
• Hypotension: measurable drop in blood pressure.
• Nausea: mild gastrointestinal upset.
• Palpitations: awareness of heartbeats.

Serious or Rare Side Effects

• Severe hypotension: marked blood pressure reduction requiring medical attention.
• Syncope: sudden loss of consciousness.
• Life‑threatening arrhythmias: irregular heart rhythms that may be fatal.
• Myocardial infarction (rare): heart attack occurring despite therapy.
• Anaphylaxis: severe allergic reaction with airway compromise.
• Stevens‑Johnson syndrome: rare skin and mucous membrane disorder.

Careful patient assessment and monitoring are essential when prescribing Isosorbide Mononitrate.

• Dose titration: start with a low dose and increase gradually to minimise hypotension.
• Blood pressure monitoring: check regularly, especially after dose changes.
• Concomitant PDE‑5 inhibitors: avoid due to risk of profound hypotension.
• Hepatic or renal impairment: use with caution and consider dose adjustment.
• Known hypersensitivity: contraindicated in patients with documented nitrate allergy.
• Store at room temperature: keep in the original container, protect from moisture and heat.

Isosorbide Mononitrate can interact with several drug classes, requiring attention to avoid adverse outcomes.

Major Interactions (Avoid)

• Other nitrates (e.g., nitroglycerin): additive vasodilatory effect leading to severe hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil): risk of profound blood pressure fall.
• Potent vasodilators (e.g., hydralazine): may cause dangerous drops in blood pressure.
• Alcohol: can enhance hypotensive effects.
• Guanylate cyclase stimulators: synergistic vasodilation.

Moderate Interactions (Monitor Closely)

• Antihypertensives (ACE inhibitors, beta‑blockers): may require dose adjustment.
• Diuretics: increased risk of volume depletion and hypotension.
• Calcium channel blockers: additive blood pressure‑lowering effect.
• Antiplatelet agents (aspirin, clopidogrel): monitor for bleeding.
• CYP3A4 inhibitors (e.g., ketoconazole): may increase plasma levels of the nitrate.