page147
Side-effects
see under Glyceryl Trinitrate
Dose
. By mouth,
daily in divided doses,
angina 30–120 mg,
left ventricular failure 40–160 mg,
up to 240 mg if
required
.
By intravenous infusion, 2–10 mg/hour; higher doses
up to 20 mg/hour may be required
Short-acting tablets and sprays
Isosorbide Dinitrate
(Non-proprietary)
Tablets
,
isosorbide dinitrate 10 mg,
net price 56-tab
pack = £12.24;
20 mg,
56-tab pack = £13.50
Angitak
c
(LPC)
Aerosol spray
,
isosorbide dinitrate 1.25 mg/metered
dose,
net price 200-dose unit = £3.95
Dose
treatment or prophylaxis of angina, spray 1–3 doses under
tongue whilst holding breath;
allow 30 second interval between
each dose
Modified-release preparations
Isoket Retard
c
(UCB Pharma)
Retard-20 tablets
,
m/r,
scored,
isosorbide dinitrate
20 mg,
net price 56-tab pack = £2.58.
Label:
25
Retard-40 tablets
,
m/r,
scored,
isosorbide dinitrate
40 mg,
net price 56-tab pack = £6.36.
Label:
25
Dose
prophylaxis of angina,
40 mg daily in 1–2 divided doses,
increased if necessary to 60–80 mg daily in 2–3 divided doses
Parenteral preparations
Isoket
c
(UCB Pharma) A
Injection 0.1%
,
isosorbide dinitrate 1 mg/mL.
To be
diluted before use.
Net price 10-mL amp = £2.69
Note
Glass or polyethylene infusion apparatus is preferable;
loss
of potency if PVC used
ISOSORBIDE MONONITRATE
Indications
prophylaxis of angina;
adjunct in conges-
tive heart failure
Cautions
see under Glyceryl Trinitrate
Contra-indications
see under Glyceryl Trinitrate
Hepatic impairment
see under Glyceryl Trinitrate
Renal impairment
see under Glyceryl Trinitrate
Pregnancy
manufacturers advise avoid unless poten-
tial benefit outweighs risk
Breast-feeding
see under Glyceryl Trinitrate
Side-effects
see under Glyceryl Trinitrate
Dose
. Initially 20 mg 2–3 times daily
or
40 mg twice daily
(10 mg twice daily in those who have not previously
received nitrates); up to 120 mg daily in divided doses
if required
Isosorbide Mononitrate
(Non-proprietary)
Tablets
, isosorbide mononitrate 10 mg, net price 56 =
£1.05; 20 mg, 56 = £1.08; 40 mg, 56 = £1.40. Label: 25
Brands include
Angeze
c
Elantan
c
(UCB Pharma)
Elantan 10 tablets
,
scored,
isosorbide mononitrate
10 mg,
net price 56-tab pack = £1.32;
84-tab pack =
£4.97.
Label:
25
Elantan 20 tablets
,
scored,
isosorbide mononitrate
20 mg,
net price 56-tab pack = £1.73;
84-tab pack =
£6.13.
Label:
25
Elantan 40 tablets
,
scored,
isosorbide mononitrate
40 mg,
net price 56-tab pack = £2.81;
84-tab pack =
£10.56.
Label:
25
Ismo
c
(Riemser)
Ismo 10 tablets
,
isosorbide mononitrate 10 mg,
net
price 60-tab pack = £3.31.
Label:
25
Ismo 20 tablets
,
scored,
isosorbide mononitrate
20 mg,
net price 60-tab pack = £4.85.
Label:
25
Modified release
Chemydur
c
60XL
(Sovereign) A
Tablets
,
m/r,
scored,
ivory,
isosorbide mononitrate
60 mg,
net price 28-tab pack = £3.99.
Label:
25
Dose
prophylaxis of angina, 1 tablet in the morning (half a tablet
for 2–4 days to minimise possibility of headache),
increased if
necessary to 2 tablets
Elantan LA
c
(UCB Pharma)
Elantan LA 25 capsules
,
m/r,
brown/white,
enclos-
ing white micropellets, isosorbide mononitrate 25 mg,
net price 28-cap pack = £2.64.
Label:
25
Dose
prophylaxis of angina, 1 capsule in the morning, increased
if necessary to 2 capsules
Elantan LA 50 capsules
, m/r, brown/pink, enclosing
white micropellets, isosorbide mononitrate 50 mg, net
price 28-cap pack = £3.69.
Label:
25
Dose
prophylaxis of angina,
1 capsule daily in the morning,
increased if necessary to 2 capsules
Imdur
c
(AstraZeneca)
Durules
c
(= tablets m/r),
yellow,
f/c,
scored,
iso-
sorbide mononitrate 60 mg,
net price 28-tab pack =
£10.50.
Label:
25
Dose
prophylaxis of angina, 1 tablet in the morning (half a tablet
if headache occurs),
increased to 2 tablets in the morning if
required
Isib 60XL
c
(Ranbaxy)
Tablets
,
m/r,
scored,
yellow,
isosorbide mononitrate
60 mg,
net price 28-tab pack = £8.15.
Label:
25
Dose
prophylaxis of angina, 1 tablet in the morning (half a tablet
for 2–4 days if headache occurs),
increased if necessary to 2
tablets
Note
Also available as Cibral 60XL
c
,
Xismox 60XL
c
Ismo Retard
c
(Riemser)
Tablets
,
m/r,
s/c,
isosorbide mononitrate 40 mg,
net
price 30-tab pack = £10.71.
Label:
25
Dose
prophylaxis of angina,
1 tablet daily in morning
Isodur
c
(Galen)
Isodur 25XL capsules
, m/r, brown/white, isosorbide
mononitrate 25 mg,
net price 28-cap pack = £5.50.
Label:
25
Isodur 50XL capsules
,
m/r,
brown/red,
isosorbide
mononitrate 50 mg,
net price 28-cap pack = £6.50.
Label:
25
Dose
prophylaxis of angina,
25–50 mg daily in the morning,
increased if necessary to 50–100 mg once daily
Isotard
c
(ProStrakan)
Isotard 25XL tablets
,
m/r,
ivory,
isosorbide mono-
nitrate 25 mg, net price 28-tab pack = £5.95. Label: 25
Isotard 40XL tablets
,
m/r,
ivory,
isosorbide mono-
nitrate 40 mg, net price 28-tab pack = £6.78. Label: 25
Isotard 50XL tablets
,
m/r,
ivory,
isosorbide mono-
nitrate 50 mg, net price 28-tab pack = £6.78. Label: 25
Isotard 60XL tablets
,
m/r,
ivory,
isosorbide mono-
nitrate 60 mg, net price 28-tab pack = £5.75. Label: 25
Dose
prophylaxis of angina,
25–60 mg daily in the morning (if
headache occurs with 60-mg tablet,
half a 60-mg tablet may be
given for 2–4 days),
increased if necessary to 50–120 mg daily
Modisal XL
c
(Sandoz)
Tablets
, m/r, ivory, isosorbide mononitrate 60 mg, net
price 28-tab pack = £10.36.
Label:
25
Dose
prophylaxis of angina, 1 tablet daily in the morning (half a
tablet for first 2–4 days to minimise possibility of headache),
increased if necessary to 2 tablets once daily
BNF 61
2.6.1 Nitrates
127
2
Cardiovascular system