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Active ingredients
Isosorbide mononitrate
Release form
Pills
Composition
Active ingredient: isosorbide mononitrate1 tablet contains isosorbide mononitrate diluted, equivalent to isosorbide mononitrate 20 mg or 40 mg excipients: lactose, microcrystalline cellulose, corn starch, talc, magnesium stearate.
Pharmacological effect
Antianginal drug. Peripheral vasodilator with a predominant effect on the venous vessels. Stimulates the formation of nitric oxide (endothelial relaxing factor) in the vascular endothelium, which causes the activation of intracellular guanylate cyclase, a consequence of this is an increase in the level of cGMP (vasodilation mediator). It reduces myocardial oxygen demand by reducing preload and afterload. It has a coronary expanding action. Reduces blood flow to the right atrium, helps reduce pressure in the pulmonary circulation and regression of symptoms in pulmonary edema. It promotes the redistribution of coronary blood flow in the area with reduced blood supply. Increases exercise tolerance in patients with coronary artery disease, angina pectoris. Expands the vessels of the brain, dura mater, which may be accompanied by headache. As with other nitrates, the drug develops cross-tolerance. After withdrawal (interruption of treatment), sensitivity to the drug is quickly restored. The antianginal effect develops within 30-45 minutes after taking the drug and lasts up to 8-10 hours.
Indications
Prevention of angina pectoris. Congestive heart failure.
Contraindications
Hypersensitivity to the active substance or to any of the components of the drug. Acute circulatory failure, severe hypotension (systolic pressure below 90 mm Hg) or hypovolemia, collapse. cardiogenic shock, if a sufficiently high end diastolic pressure in the left ventricle is not ensured by the use of intra-aortic counterpulsation or drugs with a positive inotropic effect. Acute myocardial infarction with a low filling pressure of the left ventricle. Severe anemia. Toxic pulmonary edema.Recently suffered a head injury or cerebral hemorrhage, increased intracranial pressure. Glaucoma. Hypersensitivity to nitrates. The simultaneous use of sildenafil and other phosphodiesterase inhibitors.
Precautionary measures
On the part of the cardiovascular system: nitrate headache, dizziness, transient flushing of the skin, sensation of heat, tachycardia, marked reduction in blood pressure; rarely, paradoxical intensification of angina attacks, orthostatic collapse. On the part of the digestive system: nausea, vomiting, dry mouth, you may feel a slight burning sensation of the tongue. From the side of the central nervous system: stiffness, drowsiness, blurred vision, reduced ability to rapid mental and motor responses (especially at the beginning of treatment); rarely - brain ischemia.
Use during pregnancy and lactation
Use during pregnancy is possible only in cases where the intended benefit to the mother outweighs the potential risk to the fetus.
Dosage and administration
The drug is used inside before eating, without chewing, with a sufficient amount of liquid. The dose and frequency of reception sets the doctor individually. To achieve the maximum therapeutic effect, individual dosing of the drug is recommended depending on the patient's condition, his reaction to the drug and tolerability. Start treatment with low doses, which in the process of treatment, if necessary, increase. The recommended dose is 40 mg 2 times a day. In most cases, prescribe 20 mg 2 times a day or 40 mg 2 times a day in the morning and after lunch. In order to prevent the development of tolerance to nitrates (in any dosing regimen), the second pill is recommended to be taken no earlier than 8:00 after taking the first one. In the treatment of angina with frequent nocturnal attacks, the drug should be used in the morning and immediately before bedtime. Hemodynamic monitoring is important for determining individual dosing. The daily dose, depending on the severity of the disease, can reach 120 mg (maximum daily dose), divided into 3 doses. Children. The drug does not apply to children.
Side effects
On the part of the nervous system headache, which gradually decreases over several days, but can be strong and stable. absent-mindedness, dizziness, drowsiness and weakness, motor restlessness, fainting. From the side of the cardiovascular system arterial (includingorthostatic) hypotension, collapse with cardiac arrhythmias and bradycardia, increased symptoms of angina, bradyarrhythmia, reflex tachycardia, shifting hypoxemia with myocardial hypoxia in patients with ischemic heart disease. In the digestive tract, nausea, vomiting, diarrhea, vomiting, diarrhema, i'm vomiting, diarrhema, i'm vomiting, heart failure, nausea, vomiting, heart failure, nausea, vomiting, heart failure. cellulose skin allergic reactions (including rash, itching, exfoliative dermatitis), dilatation of skin vessels with redness, pallor, and increased sweating. From the immune system in patients with ind and hypersensitivity to the components of the drug, hypersensitivity reactions are possible. Other facial hyperemia, tinnitus, asthenia. There have been cases of tolerance to the drug, incl. cross-tolerance to other organic nitrates. To prevent a weakening of the effect of the use or the complete inefficiency of the drug, it is recommended to avoid the continuous use of high doses for a long time.
Overdose
Symptoms: headache, dizziness, palpitations, hyperthermia, skin flushing, sweating, nausea, vomiting, diarrhea, methemoglobinemia (cyanosis, anoxia), hyperpnoea, dyspnea, bradycardia, seizures, visual disturbances, increased intracranial pressure, collapse, fainting, paralysis, coma. Treatment: gastric lavage; with methemoglobinemia - inside or in / in ascorbic acid 1 g, in / in - 1% methylthioninium chloride (methylene blue) solution in a dose of 1-2 mg / kg body weight. Symptomatic therapy in severe hypotension - in / in phenylephrine (epinephrine and related compounds are ineffective).
Interaction with other drugs
With the joint use of Monosan increases the concentration of dihydroergotamine in the blood plasma. With combined use, barbiturates accelerate biotransformation and reduce the concentration of isosorbide mononitrate in the blood plasma. When combined with the use of isosorbide mononitrate with antihypertensive drugs, peripherals, ancillary tract, peps, antipsychotics (neuroleptics), tricyclic antidepressants, novocainamide, ethanol, quinidine, beta-blockers, slow calcium channel blockers, dihydroephroxanone, idiocyanide, ethanol, quinidine, beta-blockers, slow calcium channel blockers, dihydro-calcium blockers, dihydroxia, quinidine.With the combination of amiodarone, propranolol, blockers of slow calcium channels (verapamil, nifedipine, etc.), acetylsalicylic acid and isosorbide mononitrate, the antianginal effect may be enhanced. When combined with beta-blockers, alpha-blockers may decrease the severity of antianginal effect (the development of tachycardia, excessive reduction of blood pressure). When combined with the use of m-anticholinergic (atropine) increases the likelihood of increased intraocular pressure. When taken simultaneously, adsorbents, binders and coating agents reduce the absorption of isosorbide mononitrate from the gastrointestinal tract.
special instructions
Monosan is not used for the relief of strokes. During the period of therapy it is necessary to monitor blood pressure, heart rate. If necessary, the use of the drug on the background of arterial hypotension should simultaneously take drugs that have a positive inotropic effect. Frequent intake and use in high doses can cause the development of tolerance; in this case, after 3-6 weeks of regular use, it is recommended that Monosan be discontinued for 24-48 hours or a break in therapy for 3-5 days with replacement of the drug for this time with other antianginal drugs. It is necessary to avoid abrupt withdrawal of the drug and reduce the dose gradually. Influence on the ability to drive vehicles and control mechanisms During the period of use of the drug may reduce the patient's psychomotor reactions, so you should be careful to drive vehicles and engage in potentially hazardous activities that require high concentration of attention and speed of psychomotor reactions.