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Isosorbide mononitrate
ℹ️ About
Always check the BNF link here 📖 for up-to-date information.
⚙️ Mode of Action
- Nitric oxide (NO) donor → increases cGMP in vascular smooth muscle → vasodilation (predominantly venous) → reduced preload and myocardial oxygen demand.
💊 Indications & Dose
- Stable angina / left ventricular failure (LVF): Isosorbide mononitrate 20–40 mg orally, up to TDS (three times daily).
- To avoid tachyphylaxis, ensure a nitrate-free interval overnight.
⚠️ Interactions
- Concurrent use with PDE-5 inhibitors (e.g. sildenafil, tadalafil) may cause severe, potentially fatal hypotension 💥.
- Caution with other antihypertensives → additive BP lowering.
🔎 Cautions
- See BNF — use carefully in patients with hypovolaemia, aortic/mitral stenosis, raised intracranial pressure, or severe anaemia.
🚫 Contraindications
- See BNF — marked hypotension, acute circulatory failure, cardiogenic shock (unless adequate BP maintained), concurrent PDE-5 inhibitor use.
❗ Side Effects
- Headache (very common, due to cerebral vasodilation) 🤕
- Reflex tachycardia 💓
- Hypotension, dizziness, flushing 📉
- Tolerance with continuous use >24 h (hence need for nitrate-free period).
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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