Formulary
Isosorbide mononitrate: Indications, Dosing, Side Effects and Interactions
Isosorbide mononitrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Isosorbide mononitrate: Indications, Dosing, Side Effects and Interactions
Isosorbide mononitrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Prophylaxis of angina,Adjunct in congestive heart failure**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 20 mg 2-3 times a day, alternatively initially 40 mg twice daily, increased if necessary up to 120 mg daily in divided doses.
**Prophylaxis of angina (**
- **Adult** (By Mouth Using Immediate-Release Medicines): for patients who have not previously had a nitrate), Adjunct in congestive heart failure (for patients who have not previously had a nitrate) Initially 10 mg twice daily, increased if necessary up to 120 mg daily in divided doses.
**Prophylaxis of angina**
- **Adult** (By Mouth): Initially 30 mg once daily for 2-4 days, to minimise the occurrence of headache, then 40-60 mg once daily, increased if necessary to 80-120 mg once daily, dose to be taken in the morning.
Cautions
Heart failure due to obstruction; hypothermia; hypothyroidism; hypoxaemia; malnutrition; metal-containing transdermal systems should be removed before magnetic resonance imaging procedures, cardioversion, or diathermy; recent history of myocardial infarction; susceptibility to angle-closure glaucoma; tolerance; ventilation and perfusion abnormalities Cautions, further information Tolerance Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 12 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for 8-12 hours (usually overnight) in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate if prescribed a long-acting nitrate with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls).
Contraindications
Aortic stenosis; cardiac tamponade; constrictive pericarditis; hypertrophic cardiomyopathy; hypotensive conditions; hypovolaemia; marked anaemia; mitral stenosis; raised intracranial pressure due to cerebral haemorrhage; raised intracranial pressure due to head trauma; toxic pulmonary oedema
Side effects
Common or very common Arrhythmias; asthenia; cerebral ischaemia; dizziness; drowsiness; flushing; headache; hypotension; nausea; vomiting Uncommon Circulatory collapse; diarrhoea; skin reactions; syncope Side-effects For isosorbide mononitrate Rare or very rare Myalgia
Interactions
**Severe interactions:**
- Concomitant administration of Monomil XL/Carmil XL tablets and Phosphodiesterase Type 5 Inhibitors can potentiate the vasodilatory effect of Monomil XL/Carmil XL tablets with the potential result of...
Pregnancy
Manufacturers advise avoid unless potential benefit outweighs risk.
Breast feeding
No information available-manufacturers advise use only if potential benefit outweighs risk.
Hepatic impairment
In general, manufacturers advise caution in severe impairment.
Renal impairment
In general, manufacturers advise caution in severe impairment.
Medicinal forms
Solution,Tablet,Tablet,Capsule
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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