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(EYE-sos-ORE-bide MAH-no-NYE-trate)
ISMO, Imdur, Monoket, Isotrate ER
Class: Antianginal

 Action Relaxation of smooth muscle of venous and arterial vasculature.

 Indications Prevention of angina pectoris.

 Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic hypotension; head trauma or cerebral hemorrhage.

 Route/Dosage

ADULTS: PO 20 mg bid, given 7 hr apart. Extended release tablets are given as 30 (½ of 60 mg tablet) or 60 mg once daily. After several days dosage may be increased to 120 mg (given as two 60 mg tablets) once daily. Rarely, 240 mg may be required.

 Interactions

Alcohol: Severe hypotension and cardiovascular collapse may occur. Aspirin: Increased nitrate concentration and actions. Calcium channel blockers: Symptomatic orthostatic hypotension. Dihydroergotamine: Increased systolic BP and decreased antianginal effects may develop.

 Lab Test Interferences May cause false report of reduced serum cholesterol with Zlatkis-Zak color reaction.

 Adverse Reactions

CV: Tachycardia; palpitations; hypotension; syncope; arrhythmias. CNS: Headache; apprehension; weakness; vertigo; dizziness; agitation; insomnia. DERM: Cutaneous vasodilation with flushing. EENT: Blurred vision. GI: Nausea; vomiting; diarrhea; dyspepsia. GU: Dysuria; urinary frequency; impotence. HEMA: Methemoglobinemia; hemolytic anemia. OTHER: Arthralgia; perspiration; pallor; cold sweat; edema.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Special risk patients: Use with caution in patients with acute MI, CHF, glaucoma or angina caused by hypertrophic cardiomyopathy. Acute angina: Not indicated for treatment of acute anginal episodes. Orthostatic hypotension: May occur even with small doses; alcohol accentuates this reaction. Tolerance: Tolerance to vascular and antianginal effects may develop.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer first dose on awakening and second dose 7 hr later.
  • Give on empty stomach with full glass of water.
  • Tablets should not be crushed or chewed and should be swallowed together.
  • Store at cool temperature in tightly closed container.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Monitor for headache, hypotension, and tachycardia.
OVERDOSAGE: SIGNS & SYMPTOMS
  Hypotension, tachycardia, flushing, diaphoresis, headache, vertigo, palpitations, visual disturbances, nausea, vomiting, confusion, dyspnea

 Patient/Family Education

  • Instruct patient to take medication twice daily, with first dose in morning and second dose 7 hr later.
  • Extended release tablets should be taken in the morning on rising.
  • Do not crush or chew tablets.
  • Caution patient not to stop taking medication suddenly; withdrawal syndrome may occur.
  • Advise patient to notify physician if effectiveness of therapy decreases over time; tolerance may develop.
  • Instruct patient to report the following symptoms to physician: Nausea, vomiting, abdominal pain, appetite loss, persistent headache, faintness, apprehension, restlessness, chest pain, flushing, excessive sweating, cold sweat, visual disturbances, fever, involuntary passing of urine and feces.
  • Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
  • Instruct patient to avoid intake of alcoholic beverages or alcohol-containing products.

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