It has vasodilating and antianginal effects. Reduces preload (through the expansion of peripheral veins) and afterload (due to a decrease in total peripheral vascular resistance) reduces the myocardial oxygen demand, increases coronary artery and improves coronary blood flow, contributes to its redistribution in the ischemic area, reduces end-diastolic volume of the left ventricle and reduced systolic tension of its walls. Increases exercise tolerance in patients with coronary heart disease, lowers blood pressure in the testosterone cypionate vs propionate pulmonary circulation.
Isosorbide mononitrate is relaxation of the muscles of the bronchi, the urinary tract, muscle of the gallbladder, biliary tract and esophagus, as well as small and large intestines, including the sphincters.
The drug is rapidly and completely absorbed in the intestine after ingestion. Bioavailability is 90 to 100%. There is a direct relationship between blood concentration of the drug dose received. Isosorbide mononitrate is derived almost exclusively via the kidneys as metabolites. Approximately 2% is excreted unchanged. The half-life is 4-5 hours.
- Prevention of angina attacks.
- Treatment of chronic heart failure in combination with cardiac glycosides, diuretics, ACE inhibitors, arterial vasodilators.-Increase The pressure in the pulmonary circulation (pulmonary hypertension).Contraindications
- hypersensitivity to organic nitrates
- acute circulatory disorders (shock, circulatory collapse)
- cardiogenic shock, if you do not provide a sufficiently high end-diastolic pressure in the left ventricle through the use of intra-aortic counterpulsation or by the administration of drugs that have a positive inotropic effect
- concomitant use of phosphodiesterase inhibitor sildenafil (of Viagra ® , Viagra), because sildenafil potentiates the antihypertensive effect of nitrates
- severe hypotension (systolic blood pressure less than 90 mm Hg, diastolic blood pressure less than 60 mmHg)
- hemorrhagic stroke, angle-closure glaucoma, traumatic brain injury, hyperthyroidism, idiopathic hypertrophic subaoralny stenosis, deficiency of glucose-6-phosphate dehydrogenase, liver and kidney failure, age 18 years
Monolong should be taken with caution in the following cases:
- constrictive pericarditis, pericardial tamponade
- low filling pressure in acute myocardial infarction, impaired function of the left chamber of the heart (left ventricular failure). There should be no reduction in systolic blood pressure below 90 mm Hg
- aortic and / or mitral stenosis, a tendency to orthostatic vascular disorders of regulation expressed cerebral atherosclerosis, diseases accompanied by intracranial hypertension
Monolong should not be used for the relief of acute attacks of angina and acute myocardial infarction.Pregnancy and lactation
For security reasons Monolong can be used during pregnancy and lactation only if the benefit to the mother outweighs the potential risk to the fetus / child, because to date, little is known about the consequences of its use in pregnant testosterone cypionate vs propionate women and lactating mothers.
Effects on ability to drive and use machines
During treatment is not recommended to drive vehicles and doing other potentially hazardous activities that require a rapid psychomotor reactions.
In the period of treatment should be deleted alcohol.
Dosage and administration
Capsules swallowed whole with water. For a more rapid absorption of the drug it is preferred to take 1 hour or 2 hours after meals.
The dosage should be adjusted according to the characteristics and tolerability individual patients. With the deterioration of the patient, or reducing the effectiveness of the drug may need to increase the dose.
Treatment is recommended to start with the lowest dosage form containing isosorbide mononitrate, that is 40 mg once a day. If the dose is insufficient – it is possible to increase the 1 to 60 mg once daily.
In rare cases, the dose can be increased to 80 mg per day (2 capsules of 40 mg). The duration of treatment and increasing the dose determined by the physician. The efficacy and safety of the drug has not been established in children.
“Nitrate” headache may occur at the beginning of treatment. With continued therapy, it usually decreases after a few days.
After the first dose or after increasing the dose of the drug can occur lowering blood pressure and / or the development of orthostatic hypotension, which may be accompanied by tachycardia, dizziness, and weakness.
May very rarely celebrated nausea, vomiting, redness . face and allergic skin reactions
in rare cases, a pronounced reduction in blood pressure is accompanied by worsening angina (a paradoxical reaction to nitrates).
occasionally there were cases collaptoid states, sometimes with bradyarrhythmia and syncope. Notes: Describes the development of tolerance, as well as cross-tolerance to other nitro compounds at long-term continuous treatment with high doses of isosorbide mononitrate. To prevent degradation or loss of effectiveness, to avoid continuous administration of high doses of the drug and drug administration more than 2 times per day. The use Monolonga can lead to transient hypoxia due to the relative blood flow redistribution gipoventiliruemye alveolar segments. It can be a trigger of ischemia in patients with coronary heart disease.
Overdose Symptoms of overdose: Lowering blood pressure with orthostatic dysregulation, reflex tachycardia, and headache. May develop fatigue, dizziness, somnolence, sweating, hot flushes, nausea and vomiting, diarrhea hyperpnoea, dyspnea, bradycardia, increased intracranial pressure, paralysis, coma. In chronic overdose may cause a higher level of methemoglobin. Therapy with overdose In addition to general recommendations such as washing stomach and placing the patient in a horizontal position, legs raised high, with marked decrease srterialnogo pressure and / or patients in shock should be the introduction of fluid; in exceptional cases, to improve blood circulation can be performed infusion of norepinephrine and / or dopamine. Introduction of epinephrine and related compounds is contraindicated.When methemoglobinemia – intravenous injection of 1% methylene blue solution, 1.2 mg / kg.
Interaction with other drugs
When using with other vasodilators, antihypertensive drugs, beta-blockers, blockers “slow” calcium channel blockers, antipsychotics or tricyclic anti-depressants, amiodarone, a phosphodiesterase inhibitor sildenafil testosterone cypionate vs propionate and alcohol may potentiation of anti-anginal action drug.
with the simultaneous introduction Monolonga and dihydroergotamine can occur raising dihydroergotamine and potentiation of the hypertensive action.
The therapeutic effect of noradrenaline is reduced when taken with nitropreparatov.
The combined use with M-holinoblokatorami (atropine, and others.) increases the likelihood of increased intraocular pressure .
Adsorbents, binders and overlying means reduce the absorption of isosorbide mononitrate in the digestive tract.
Under the influence of sympathomimetic alpha-blockers (dihydroergotamine, etc.) may reduce the severity of anti-anginal effect (excessive reduction in blood pressure and, as a consequence, coronary perfusion). Barbaturaty accelerate the metabolism and reduce the concentration of isosorbide mononitrate in the blood.
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