Mononitrato De Isossorbido Mylan (Isosorbide Mononitrate)

Isosorbide mononitrate is an anti‑anginal nitrate that reduces myocardial oxygen demand and improves cardiac output.

• Angina pectoris: decreases the frequency and severity of chest pain episodes.
• Chronic heart failure: enhances exercise tolerance and reduces symptoms of fluid overload.
• Stable coronary artery disease: helps prevent ischemic episodes during daily activities.

• Isosorbide mononitrate is metabolized to nitric oxide, which activates guanylate cyclase in vascular smooth muscle. The resulting increase in cyclic GMP causes relaxation of arterial and venous walls, producing vasodilation that lowers preload and afterload, thereby reducing myocardial oxygen consumption and alleviating ischemic symptoms.

Isosorbide mononitrate may cause a range of adverse reactions, most of which are dose‑related and reversible.

Common Side Effects

• Headache: mild to moderate, often transient.
• Dizziness or light‑headedness, especially on standing.
• Flushing: warmth and redness of the skin.
• Nausea or abdominal discomfort.
• Palpitations: sensation of rapid or irregular heartbeat.

Serious or Rare Side Effects

• Severe hypotension: marked drop in blood pressure requiring medical attention.
• Syncope: fainting episodes due to sudden blood pressure fall.
• Methemoglobinemia: rare disorder affecting oxygen transport.
• Allergic reactions: rash, itching, or swelling of the face and throat.

Before initiating therapy, clinicians should evaluate patient history and comorbid conditions.

• Cardiovascular status: assess for hypotension or recent myocardial infarction.
• Concomitant nitrate use: avoid combined therapy to prevent severe hypotension.
• Phosphodiesterase‑5 inhibitors: do not co‑administer with drugs such as sildenafil.
• Renal or hepatic impairment: adjust monitoring as clearance may be altered.
• Pregnancy and lactation: use only if potential benefit justifies potential risk.
• Store at ambient temperature: keep below 25 °C, in the original container, protected from moisture and direct sunlight.

Isosorbide mononitrate interacts with several drug classes that influence vascular tone or nitric‑oxide pathways.

Major Interactions (Avoid)

• Other nitrates or nitroglycerin: additive vasodilatory effect leading to profound hypotension.
• Phosphodiesterase‑5 inhibitors (e.g., sildenafil, tadalafil): risk of severe blood pressure drop.

Moderate Interactions (Monitor Closely)

• Antihypertensives (ACE inhibitors, beta‑blockers, diuretics): may enhance blood pressure‑lowering effect.
• Alcohol: can increase dizziness and hypotensive episodes.
• Certain antacids (aluminum‑containing): may affect absorption if taken simultaneously.