Imdur: Effective Long-Acting Nitrate for Angina Prevention
Imdur
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| Product dosage: 60mg | |||
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Synonyms | |||
Imdur (isosorbide mononitrate) is a long-acting nitrate medication specifically designed for the prophylactic management of angina pectoris. It works by dilating coronary arteries and peripheral vessels, reducing cardiac preload and afterload, thereby decreasing myocardial oxygen demand. This makes it a cornerstone in the prevention of angina episodes, offering sustained protection and improving functional capacity in patients with chronic stable angina. Clinical evidence supports its role in enhancing exercise tolerance and reducing the frequency of anginal attacks.
Features
- Active ingredient: Isosorbide mononitrate
- Pharmacological class: Organic nitrate vasodilator
- Formulation: Extended-release tablets
- Available strengths: 30 mg, 60 mg, and 120 mg
- Administration: Oral, once-daily dosing
- Mechanism: Converts to nitric oxide, causing venous and arterial dilation
Benefits
- Reduces the frequency and severity of angina attacks
- Improves exercise tolerance and daily activity capacity
- Provides 24-hour prophylactic coverage with once-daily dosing
- Decreases myocardial oxygen demand through preload and afterload reduction
- Well-established safety and efficacy profile in clinical use
- Compatible with many other antianginal therapies for comprehensive management
Common use
Imdur is primarily indicated for the prevention of angina pectoris due to coronary artery disease. It is not intended for the acute relief of anginal episodes but rather for long-term prophylaxis. It is often prescribed as part of a comprehensive management plan that may include beta-blockers, calcium channel blockers, lifestyle modifications, and risk factor management. Its extended-release formulation ensures consistent plasma levels, supporting uninterrupted protection against ischemic symptoms.
Dosage and direction
The usual starting dose for Imdur is 30 mg or 60 mg orally once daily, preferably in the morning. Dosage may be titrated upward based on therapeutic response and tolerability, with a maximum recommended dose of 240 mg daily. Tablets should be swallowed whole and must not be crushed, chewed, or split, as this alters the release profile. It is advisable to take Imdur on an empty stomach to minimize potential headaches. A nitrate-free interval of 10–14 hours is recommended to prevent tolerance; thus, dosing is typically scheduled to allow for this period.
Precautions
Patients should be advised that Imdur can cause hypotension, especially upon standing, and should rise slowly from a seated or lying position. Use with caution in patients with hypovolemia, hypotension, or hypertrophic cardiomyopathy. Headache is common initially but often diminishes with continued therapy; analgesics may be used if needed. Alcohol consumption should be avoided as it may potentiate hypotensive effects. Imdur should not be used in patients with severe anemia, increased intracranial pressure, or pericardial tamponade.
Contraindications
Imdur is contraindicated in patients with a known hypersensitivity to nitrates or any component of the formulation. It must not be used concurrently with phosphodiesterase type 5 inhibitors (e.g., sildenafil, tadalafil, vardenafil) due to the risk of severe hypotension and cardiovascular collapse. Additional contraindications include patients with acute myocardial infarction with low filling pressures, cardiogenic shock, or conditions associated with elevated intracranial pressure.
Possible side effect
Common side effects include headache (often dose-related), dizziness, lightheadedness, and nausea. Less frequently, patients may experience orthostatic hypotension, flushing, syncope, or reflex tachycardia. Cutaneous vasodilation and weakness have also been reported. Most adverse effects are dose-dependent and may decrease over time. Serious but rare side effects include methemoglobinemia, particularly at high doses or in susceptible individuals.
Drug interaction
Concomitant use with phosphodiesterase-5 inhibitors is absolutely contraindicated due to life-threatening hypotension. Antihypertensive agents, beta-blockers, calcium channel blockers, alcohol, and other vasodilators may potentiate hypotensive effects. Aspirin may increase nitrate bioavailability, while ergot alkaloids may antagonize the antianginal effects. Always review the patient’s full medication list to avoid interactions.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the usual dosing schedule. Do not double the dose to make up for a missed one. Maintaining a consistent daily routine is important for therapeutic efficacy.
Overdose
Symptoms of overdose include severe hypotension, throbbing headache, vertigo, palpitations, visual disturbances, flushing, sweating, nausea, vomiting, syncope, and methemoglobinemia (evidenced by cyanosis, dyspnea, and fatigue). Management involves supportive care, including Trendelenburg positioning, intravenous fluids, and oxygen administration. In cases of methemoglobinemia, methylene blue may be indicated. Hemodialysis is not effective for nitrate removal.
Storage
Store Imdur tablets at room temperature (15–30°C or 59–86°F), in a tightly closed container, and protect from moisture and light. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or changing any medication regimen. Individual patient needs and responses may vary.
Reviews
Clinical studies and post-marketing surveillance indicate that Imdur is effective in reducing angina frequency and improving quality of life in many patients. Some users report significant improvement in exercise capacity, while others note the convenience of once-daily dosing. Common feedback includes initial headache that often subsides with continued use. Healthcare professionals appreciate its predictable pharmacokinetics and role in long-term angina management.