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Isosorbide Mononitrate

Isosorbide mononitrate is a long-acting metabolite of isosorbide dinitrate. It decreases preload as measured by pulmonary capillary wedge pressure. It is equally or more effective in the treatment of chronic, stable angina.

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Cay Sevilla
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4K views

Isosorbide Mononitrate

Isosorbide mononitrate is a long-acting metabolite of isosorbide dinitrate. It decreases preload as measured by pulmonary capillary wedge pressure. It is equally or more effective in the treatment of chronic, stable angina.

Uploaded by

Cay Sevilla
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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ISOSORBIDE MONONITRATE

(eye-soe-sor'bide)
Ismo, Imdur, Monoket
Classifications: cardiovascular agent; nitrate vasodilator
Prototype: Nitroglycerin
Pregnancy Category: C (category B for sustained release form)

Availability
10 mg, 20 mg tablets; 30 mg, 60 mg, 120 mg sustained release tablets

Actions
Isosorbide mononitrate is a long-acting metabolite of the coronary vasodilator isosorbide
dinitrate. It decreases preload as measured by pulmonary capillary wedge pressure
(PCWP), and left ventricular end volume and diastolic pressure (LVEDV), with a
consequent reduction in myocardial oxygen consumption.

Therapeutic Effects
It is equally or more effective than isosorbide dinitrate in the treatment of chronic, stable
angina. It is a potent vasodilator with antianginal and antiischemic effects.

Uses
Prevention of angina. Not indicated for acute attacks.

Contraindications
Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma, postural hypotension,
head trauma, cerebral hemorrhage (increases intracranial pressure). Safe use during
pregnancy [(category C) and (category B) for sustained form] or lactation is not
established.

Cautious Use
Older adults, hypotension.

Route & Dosage


Prevention of Angina
Adult: PO Regular release (ISMO, Monoket) 20 mg b.i.d. 7 h apart; Sustained release
(Imdur) 30–60 mg every morning, may increase up to 120 mg once daily after several
days if needed (max: dose 240 mg)

Administration
Oral
 Give first dose in morning on arising and second dose 7 h later with twice daily
dosing regimen. Give in morning on arising with once daily dosing.
 Store sustained release tablets in a tight container.

Adverse Effects ( 1%)


CNS: Headache, agitation, anxiety, confusion, loss of coordination, hypoesthesia,
hypokinesia, insomnia or somnolence, nervousness, migraine headache, paresthesia,
vertigo, ptosis, tremor. CV: Aggravation of angina, abnormal heart sounds, murmurs, MI,
transient hypotension, palpitations. Hematologic: Hypochromic anemia, purpura,
thrombocytopenia, methemoglobinemia (high doses). GI: Nausea, vomiting, dry mouth,
abdominal pain, constipation, diarrhea, dyspepsia, flatulence, tenesmus, gastric ulcer,
hemorrhoids, gastritis, glossitis. Metabolic: Hyperuricemia, hypokalemia. GU: Renal
calculus, UTI, atrophic vaginitis, dysuria, polyuria, urinary frequency, decreased libido,
impotence. Respiratory: Bronchitis, pneumonia, upper respiratory tract infection, nasal
congestion, bronchospasm, coughing, dyspnea, rales, rhinitis. Skin: Rash, pruritus, hot
flashes, acne, abnormal texture. Special Senses: Diplopia, blurred vision, photophobia,
conjunctivitis.

Interactions
Drug: Alcohol may cause severe hypotension and cardiovascular collapse. Aspirin may
increase nitrate serum levels. calcium channel blockers may cause orthostatic
hypotension.

Pharmacokinetics
Absorption: Completely and rapidly absorbed from GI tract; 93% reaches systemic
circulation. Onset: 1 h. Peak: Regular release 30–60 min; sustained release 3–4 h.
Duration: Regular release 5–12 h; sustained release 12 h. Metabolism: Metabolized in
liver by denitration and conjugation to inactive metabolites. Elimination: Excreted
primarily by kidneys. Half-Life: 4–5 h.
NURSING IMPLICATIONS
Assessment & Drug Effects

 Monitor cardiac status, frequency and severity of angina, and BP.


 Assess for and report possible S&S of toxicity, including orthostatic hypotension,
syncope, dizziness, palpitations, light-headedness, severe headache, blurred
vision, and difficulty breathing.
 Lab tests: Monitor serum electrolytes periodically.

Patient & Family Education

 Do not crush or chew sustained release tablets. May break tablets in two and take
with adequate fluid (4–8 oz).
 Do not withdraw drug abruptly; doing so may precipitate acute angina.
 Maintain correct dosing interval with twice daily dosing.
 Note: Geriatric patients are more susceptible to the possibility of developing
postural hypotension.
 Avoid alcohol ingestion and aspirin unless specifically permitted by physician.
 Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined: generic names in


bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

Copyright © 2006 Pearson Education, Inc. All Rights Reserved

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