Buy Monoket Online

Monoket (isosorbide mononitrate)

THERAPEUTIC CLASS

Nitrate vasodilator

DEA CLASS

RX

INDICATIONS

Prevention and treatment of angina pectoris due to coronary artery disease.

ADULT DOSAGE

Angina Pectoris

Prevention and Treatment:
20mg bid (give doses 7 hrs apart)

Small Stature Patients:
Initial: 5mg (1/2 of 10mg tab)
Titrate: Increase to ≥10mg by 2nd or 3rd day

DOSING CONSIDERATIONS

Elderly
Start at lower end of dosing range

ADMINISTRATION

Oral route

HOW SUPPLIED

Tab: 10mg*, 20mg* *scored

CONTRAINDICATIONS

Concomitant use with certain drugs for erectile dysfunction (phosphodiesterase inhibitors) (eg, sildenafil, tadalafil, vardenafil).

WARNINGS/PRECAUTIONS

Not useful in aborting acute anginal episode. Not recommended with acute myocardial infarction (AMI) or congestive heart failure (CHF); if used in these conditions, perform careful clinical/hemodynamic monitoring to avoid the hazards of hypotension and tachycardia. Severe hypotension, particularly with upright posture, may occur. Caution in volume-depleted, hypotensive, or elderly. Drug-induced hypotension may be accompanied by paradoxical bradycardia and increased angina pectoris. May aggravate angina caused by hypertrophic cardiomyopathy. Tolerance and physical dependence may occur.

ADVERSE REACTIONS

Headache, fatigue, upper respiratory infection, pain, dizziness, nausea.

DRUG INTERACTIONS

See Contraindications. Additive vasodilating effects with other vasodilators (eg, alcohol). Marked symptomatic orthostatic hypotension reported with calcium channel blockers; dose adjustments of either class of agents may be necessary.

PREGNANCY AND LACTATION

Category B, caution in nursing.

MECHANISM OF ACTION

Nitrate vasodilator; relaxes vascular smooth muscle, and consequently dilates peripheral arteries and veins, especially the latter. Dilation of veins leads to reduction of the left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). It also dilates the coronary arteries.

PHARMACOKINETICS

Absorption: Rapid and complete. Absolute bioavailability (nearly 100%); Tmax=30-60 min. Distribution: Plasma protein binding (<5%); Vd=0.6L/kg. Metabolism: Denitration. Elimination: Urine (93%, 2% unchanged), feces (1%); T1/2=5 hrs.

ASSESSMENT

Assess for drug hypersensitivity, AMI, CHF, volume depletion, hypotension, hypertrophic cardiomyopathy, pregnancy/nursing status, and possible drug interactions.

MONITORING

Monitor for hypotension, aggravation of angina caused by hypertrophic cardiomyopathy, tolerance, physical dependence, and other adverse reactions. Perform careful clinical/hemodynamic monitoring in patients with AMI/CHF.

PATIENT COUNSELING

Counsel to carefully follow the prescribed schedule of dosing; inform that most patients take 1st dose on awakening and the 2nd dose 7 hrs later. Advise that daily headaches may accompany treatment and are markers of drug activity; instruct to resist the temptation to avoid headaches by altering treatment schedule, since loss of headache may be associated with loss of antianginal efficacy. Inform that treatment may be associated with lightheadedness on standing (especially just after rising from recumbent/seated position) which may be more frequent with alcohol consumption.

STORAGE

20-30°C (68-86°F). Keep tightly closed.

TAGS

isosorbide mononitrate 60 mg, order monoket, purchase isosorbide mononitrate, buy isosorbide mononitrate online, isosorbide mononitrate er, isosorbide mononitrate tablets, order isosorbide mononitrate online, mononitrate isosorbide, buy cheap monoket, buy monoket online, isosorbide mononitrate brand name, purchase isosorbide mononitrate online, buy cheap isosorbide mononitrate, buy isosorbide mononitrate, isosorbide mononitrate cr, purchase monoket, isosorbide mononitrate 30 mg, order monoket online, purchase monoket online, isosorbide mononitrate online, order isosorbide mononitrate, buy monoket