Monoket

Generic name: Isosorbide Mononitrate

Drug class: Antianginal agents

Dosage form: Tablets (10 mg, 20 mg)

Route of administration: Oral

Dose:

• Adults: 20 mg upon awakening, then 20 mg 7 hours later. For small patients, may start with 5 mg per dose for 1 day, then increase to 10 mg by the 2nd or 3rd day, scheduled as above.
• Children: Not established.

Mechanism of action: Isosorbide mononitrate is a nitrate that dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump.

Drug usage cases:

• Prevention and treatment of angina pectoris (chest pain).
• Hypertension (acute) (non-FDA approved).

Drug contraindications:

• Hypersensitivity to nitrates, severe anemia, close-angle glaucoma, postural hypotension.
• Head trauma.
• Concomitant use with phosphodiesterase type 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil) or riociguat.

Side effects:

• Headache (up to 30% incidence).
• Dizziness, lightheadedness, or fainting, especially when standing up quickly.
• Flushing (warmth, redness, or tingly feeling).
• Gastrointestinal disturbances: abdominal pain, diarrhea, dyspepsia, nausea, vomiting.
• Cardiovascular effects: hypotension, tachycardia, palpitations.
• Visual disturbances: blurred vision, diplopia.
• Central nervous system effects: agitation, anxiety, confusion, insomnia, nervousness, restlessness, vertigo, weakness.
• Respiratory effects: upper respiratory infection.
• Other effects: sleep disturbances, fatigue, edema, weight loss, voice changes, tooth disorder, uncontrolled twisting movements of the neck, and others.

Warnings:

• Do not take Monoket with erectile dysfunction medicines (e.g., Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil, vardenafil) as it can cause a sudden and serious decrease in blood pressure.
• Use caution in patients with acute myocardial infarction, congestive heart failure, hypotension, volume depletion, hypertrophic cardiomyopathy, and glaucoma.
• Monitor for tolerance development with continuous use without nitrate-free intervals.
• Alcohol may increase certain side effects of isosorbide mononitrate (dizziness, drowsiness, feeling light-headed, or fainting); limit alcohol intake.
• Be cautious when driving or operating machinery as Monoket may impair your thinking or reactions.

Use during pregnancy or breastfeeding:

It is not known whether Monoket will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether isosorbide mononitrate passes into breast milk or if it could affect the nursing baby. Tell your doctor if you are breast-feeding.