Monoket (isosorbide mononitrate)
Prevention and treatment of angina pectoris due to coronary artery disease.
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
Start at lower end of dosing range
Tab: 10mg*, 20mg* *scored
Concomitant use with certain drugs for erectile dysfunction (phosphodiesterase inhibitors) (eg, sildenafil, tadalafil, vardenafil).
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.
Headache, fatigue, upper respiratory infection, pain, dizziness, nausea.
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.
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.
Assess for drug hypersensitivity, AMI, CHF, volume depletion, hypotension, hypertrophic cardiomyopathy, pregnancy/nursing status, and possible drug interactions.
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.
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.
20-30°C (68-86°F). Keep tightly closed.
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