ISOSORBIDE MONONITRATE

(eye-soe-sor'bide)
Ismo, Imdur, Monoket
Classifications: cardiovascular agent; nitrate vasodilator
Prototype: Nitroglycerin
Pregnancy Category: C (category B for sustained release form)

Availability
10 mg, 20 mg tablets; 30 mg, 60 mg, 120 mg sustained release tablets

Actions
Isosorbide mononitrate is a long-acting metabolite of the coronary vasodilator isosorbide
dinitrate. It decreases preload as measured by pulmonary capillary wedge pressure
(PCWP), and left ventricular end volume and diastolic pressure (LVEDV), with a
consequent reduction in myocardial oxygen consumption.

Therapeutic Effects
It is equally or more effective than isosorbide dinitrate in the treatment of chronic, stable
angina. It is a potent vasodilator with antianginal and antiischemic effects.

Uses
Prevention of angina. Not indicated for acute attacks.

Contraindications
Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma, postural hypotension,
head trauma, cerebral hemorrhage (increases intracranial pressure). Safe use during
pregnancy [(category C) and (category B) for sustained form] or lactation is not
established.

Cautious Use
Older adults, hypotension.

Route & Dosage

Prevention of Angina
Adult: PO Regular release (ISMO, Monoket) 20 mg b.i.d. 7 h apart; Sustained release
(Imdur) 30–60 mg every morning, may increase up to 120 mg once daily after several
days if needed (max: dose 240 mg)

Administration
Oral
 Give first dose in morning on arising and second dose 7 h later with twice daily
dosing regimen. Give in morning on arising with once daily dosing.
 Store sustained release tablets in a tight container.

Adverse Effects ( 1%)

CNS: Headache, agitation, anxiety, confusion, loss of coordination, hypoesthesia,
hypokinesia, insomnia or somnolence, nervousness, migraine headache, paresthesia,
vertigo, ptosis, tremor. CV: Aggravation of angina, abnormal heart sounds, murmurs, MI,
transient hypotension, palpitations. Hematologic: Hypochromic anemia, purpura,
thrombocytopenia, methemoglobinemia (high doses). GI: Nausea, vomiting, dry mouth,
abdominal pain, constipation, diarrhea, dyspepsia, flatulence, tenesmus, gastric ulcer,
hemorrhoids, gastritis, glossitis. Metabolic: Hyperuricemia, hypokalemia. GU: Renal
calculus, UTI, atrophic vaginitis, dysuria, polyuria, urinary frequency, decreased libido,
impotence. Respiratory: Bronchitis, pneumonia, upper respiratory tract infection, nasal
congestion, bronchospasm, coughing, dyspnea, rales, rhinitis. Skin: Rash, pruritus, hot
flashes, acne, abnormal texture. Special Senses: Diplopia, blurred vision, photophobia,
conjunctivitis.

Interactions
Drug: Alcohol may cause severe hypotension and cardiovascular collapse. Aspirin may
increase nitrate serum levels. calcium channel blockers may cause orthostatic
hypotension.

Pharmacokinetics
Absorption: Completely and rapidly absorbed from GI tract; 93% reaches systemic
circulation. Onset: 1 h. Peak: Regular release 30–60 min; sustained release 3–4 h.
Duration: Regular release 5–12 h; sustained release 12 h. Metabolism: Metabolized in
liver by denitration and conjugation to inactive metabolites. Elimination: Excreted
primarily by kidneys. Half-Life: 4–5 h.
NURSING IMPLICATIONS
Assessment & Drug Effects

 Monitor cardiac status, frequency and severity of angina, and BP.

 Assess for and report possible S&S of toxicity, including orthostatic hypotension,
syncope, dizziness, palpitations, light-headedness, severe headache, blurred
vision, and difficulty breathing.
 Lab tests: Monitor serum electrolytes periodically.

Patient & Family Education

 Do not crush or chew sustained release tablets. May break tablets in two and take
with adequate fluid (4–8 oz).
 Do not withdraw drug abruptly; doing so may precipitate acute angina.
 Maintain correct dosing interval with twice daily dosing.
 Note: Geriatric patients are more susceptible to the possibility of developing
postural hypotension.
 Avoid alcohol ingestion and aspirin unless specifically permitted by physician.
 Do not breast feed while taking this drug without consulting physician.

Common adverse effects in italic, life-threatening effects underlined: generic names in

bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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