Brands, Medical Use, Clinical Data
Drug Category
- Vasodilator Agents
- Nitrates and Nitrites
- Nitric Oxide Donors
Dosage Forms
- Tablet (immediate release)
- Tablet (extended release)
Brands / Synonyms
Conpin; Conpin Retardkaps; Corangin; Corangin Sr; Duride; Edistol; Elan; Elantan; Elantan Long; Elantan Retard; Epicordin; Etimonis; Fem-Mono; IHD; Imazin; Imdur; Imdur 60; Imdur Durules; Imodur; Imtrate; IS 5MN; Ismexin; ISMN; Ismn Abz; ISMN AL; Ismn Apogepha; Ismn Atid; Ismn Basics; Ismn Heumann; Ismn Hexal; Ismn Lannacher; Ismn Stada; Ismo; Ismo-20; Ismotic; Ismox; Isomon; Isomonat; Isomonit; Isopen-20; Isosorbidi Mononitras [Latin]; Isotrate; Iturol; Medocor; Monicor; Monis; Monisid; Monit; Monit 20; Monizid; Mono Corax; Mono Corax Retard; Mono Mack; Mono-Mack; Mono-Sanorania; Monocedocard; Monoclair; Monocord 20; Monocord 40; Monocord 50 Sr; Monodur Durules; Monoket; Monoket Od; Monoket Retard; Monolong; Monolong 40; Monolong 60; Mononit; Mononit 20; Mononit 40; Mononit Retard 50; Mononitrate d'Isosorbide [French]; Mononitrato de Isosorbida [Spanish]; Monopront; Monosigma; Monosorb; Monosorbitrate; Monosordil; Monotrate; Multitab; Nitex; Nitramin; Olicard; Olicardin; Orasorbil; Pentacard; Pentacard 20; Percorina; Pertil; Plodin; Promocard; Sigacora; Sorbimon; Titarane; Turimonit; Uniket; Vasdilat; Vasotrate
Indications
For the prevention of angina pectoris due to coronary artery disease and the treatment of acute and chronic angina pectoris, hypertension, and myocardial infarction.
Pharmacology
Isosorbide-5-mononitrate, the long-acting metabolite of isosorbide dinitrate, is used as a vasodilatory agent in the management of angina pectoris. By dilating the vessels, it lowers the blood pressure and reduces the left ventricular preload and afterload, therefore, leads to a reduction of myocardial oxygen requirement.
Mechanism of Action
Similar to other nitrites and organic nitrates, Isosorbide Mononitrate is converted to nitric oxide (NO), an active intermediate compound which activates the enzyme guanylate cyclase (Atrial natriuretic peptide receptor A). This stimulates the synthesis of cyclic guanosine 3',5'-monophosphate (cGMP) which then activates a series of protein kinase-dependent phosphorylations in the smooth muscle cells, eventually resulting in the dephosphorylation of the myosin light chain of the smooth muscle fiber. The subsequent release of calcium ions results in the relaxation of the smooth muscle cells and vasodilation.
Absorption
100%
Toxicity
Symptoms of overdose include vasodilatation, venous pooling, reduced cardiac output, and hypotension. LD50=mg/kg(orally in rat)
Biotrnasformation / Drug Metabolism
Hepatic
Contraindications
Immediate Release Tablets: Allergic reactions to organic nitrates are extremely rare, but they do
occur. Isosorbide mononitrate is contraindicated in patients who are allergic to it.
Extended Release Tablets: Isosorbide mononitrate extended release tablets are contraindicated in
patients who have shown hypersensitivity or idiosyncratic reactions to other nitrates or nitrites.
Drug Interactions
The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. Alcohol, in
particular, has been found to exhibit additive effects of this variety.
Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates
were used in combination. Dose adjustments of either class of agents may be necessary.
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