Organic nitrate
Isosorbide mononitrate
Brand names: Imdur, Monomil, Ismo, Elantan
Adult dose
Dose: PO immediate-release 20–40mg BD asymmetric dosing (nitrate-free interval). Modified-release 60–120mg OD
Route: PO
Frequency: OD-BD
Clinical pearls
- Asymmetric dosing (e.g. 8am + 2pm IR) provides nitrate-free interval to prevent tolerance
Contraindications
- Marked hypotension
- Concurrent PDE-5 inhibitors
- Severe aortic stenosis
Side effects
- Headache
- Flushing
- Hypotension
- Tachycardia
Interactions
- PDE-5 inhibitors
- Riociguat
Monitoring
- BP
Reference: BNF; NICE NG185; https://bnf.nice.org.uk/drugs/isosorbide-mononitrate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines