Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Isosorbide mononitrate is in the class of drugs
called nitrates that are used for treating and preventing angina. Other nitrates
include nitroglycerin (Nitrostat, NitroQuick, Nitrolingual, Nitro-Dur and
others) and isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron).
Nitrates are vasodilators (dilators of blood vessels). Blood returning from the
body in the veins must be pumped by the heart through the lungs and into the
body's arteries against the high pressure in the arteries. In order to
accomplish this work, the heart's muscle must produce and use energy ("fuel")
which requires oxygen brought to the heart by the blood.
Angina pectoris
(angina) or "heart pain" is due to an inadequate flow of blood (and oxygen) to
the muscle of the heart. Nitrates, including isosorbide mononitrate, correct the
imbalance between the flow of blood and oxygen to the heart and the work that
the heart must do by dilating the arteries and veins in the body. Dilation of
the veins reduces the amount of blood that returns to the heart that must be
pumped. Dilation of the arteries lowers the pressure in the arteries against
which the heart must pump. As a consequence of both effects, the heart works
less and requires less blood and oxygen.
STORAGE: Isosorbide mononitrate should be stored at room temperature, 15-30 C
(59-86 F) in a tight, moisture- proof container.
PRESCRIBED FOR: Isosorbide mononitrate is used for the treatment and
prevention of angina. It can be used to decrease the frequency and severity of
anginal (chest pain) episodes and to reduce the need for sublingual (under the
tongue) nitroglycerin.
DOSING: The recommended dose of isosorbide mononitrate is 20 mg of immediate
release tablets twice daily. The two doses should be administered 7 hours apart
in order to avoid tolerance (decreased effect after several doses). The dose for
extended release tablets is 30-240 mg once daily.
DRUG INTERACTIONS:Sildenafil (Viagra), tadalafil (Cialis) and
vardenafil
(Levitra) increase the blood pressure lowering effects of isosorbide mononitrate
and may cause excessive reductions in blood pressure. Therefore, patients taking
isosorbide mononitrate should not receive sildenafil, tadalafil or vardenafil.
Severe reductions in blood pressure, especially when changing posture
(orthostatic hypotension), may occur when isosorbide mononitrate is combined
with calcium channel blockers
[for example, diltiazem (Cardizem, Dilacor, Tiazac and several others), verapamil
(Calan, Verelan, Verelan PM, Isoptin, Isoptin SR, Covera-HS)], which also reduce
blood pressure.
PREGNANCY: There are no adequate studies of isosorbide mononitrate in
pregnant women.
NURSING MOTHERS: It is not known if isosorbide mononitrate is excreted in
human breast-milk.
SIDE EFFECTS: Headaches are the most common side effect of isosorbide
mononitrate and usually are dose related (increase with higher doses). Flushing
may occur because isosorbide mononitrate dilates (enlarges) blood vessels.
Isosorbide mononitrate may cause a severe drop in blood pressure when rising
from a sitting position, causing dizziness, palpitations, and weakness. To
reduce the risk of low blood pressure, patients should rise slowly from a
sitting position.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
Angina is chest pain that is due to an inadequate supply of oxygen to the heart muscle.
Angina can be caused by coronary artery disease or spasm of the coronary
arteries. EKG, exercise treadmill, stress echocardiography, stress thallium, and cardiac
catheterization are important tests used in the diagnosis of angina.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Chest pain is a common symptom that is caused by many different conditions. Some causes require prompt medical attention, such as angina,
heart attack, or tearing of the aorta. Other causes of chest pain that may not require immediate medical intervention include spasm of the esophagus, gallbladder attack, or inflammation of the chest wall. An accurate diagnosis is important in providing proper treatment to patients with chest pain.
The diagnosis and treatment of angina is discussed below, as well as the diagnosis of other causes of chest pain that can mimic angina.
What is angina, and what are the symptoms of angina?
Angina (angina pectoris - Latin for squeezing of the chest) is chest discomfort
that occurs when there is a decreased blood oxygen supply to an area of the
heart muscle. In most cases, the lack of blood supply is due to a narrowing of
the coronary arteries as a result of arterioscler...
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