Isosorbide Mononitrate ER

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 11, 2023

Warnings

Isosorbide Mononitrate Risks, Warnings, and Complications

Isosorbide mononitrate may cause or worsen health problems in some people. Talk to your doctor or pharmacist about other treatments for chest pain if you are at an increased risk of adverse reactions or complications from this medication. Some of the risks of taking isosorbide mononitrate include:

SEVERE HYPOTENSION: Drinking alcohol or taking medications for erectile dysfunction while on isosorbide mononitrate can lead to severe hypotension (dangerously low blood pressure). This can be life-threatening. Elderly patients are at a higher risk of this side effect. Call your doctor without delay if you feel faint (like you are going to pass out). Also, tell your doctor promptly if you develop a fast or slow heartbeat, nausea, vomiting, blurred vision, sweating, flushing, or cold and clammy skin after taking isosorbide mononitrate. Get up slowly from a sitting or lying position to lower your risk of falls due to dizziness and low blood pressure.
TOLERANCE: Long-term use of isosorbide mononitrate can make the medicine less effective over time. This means the same amount of medication might not provide relief from chest pain like it did before. This is called tolerance. Do not increase the dose of your medicine if it does not work well or you have worsening chest pain. Talk to your doctor, and they will change your dose or dose timings so that your body is not exposed to the drug for some time every day. Follow your healthcare provider's dosing instructions carefully.
ALLERGIC REACTIONS: A small number of people can develop a serious allergic reaction to isosorbide mononitrate. Seek emergency medical attention if you develop skin rash, hives, itching, swelling of the face or mouth, or difficulty breathing or swallowing.

Precautions Before Starting Isosorbide Mononitrate

Tell your doctor if you have ever had an allergic reaction to isosorbide mononitrate, any of the active or inactive ingredients in isosorbide mononitrate tablets and capsules, nitroglycerine tablets, ointment, or patches, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible interactions between your medications.

Give your doctor a complete medical history. Isosorbide mononitrate may not be right for people with certain medical conditions. Tell your doctor if you have recently been dehydrated or had a heart attack. Also, tell your doctor if you have low blood pressure, congestive heart failure, or hypertrophic cardiomyopathy. Your doctor may prescribe isosorbide mononitrate if the benefits outweigh the risks.

Tell your health care professional if you are pregnant, could be pregnant, plan to get pregnant, or are nursing an infant with breast milk.

Precautions During Use of Isosorbide Mononitrate

Take your medication regularly and keep all your medical and lab appointments during isosorbide mononitrate treatment. Your doctor may want to order certain laboratory tests, adjust your dose, or change the timing of your dose based on your response.

Isosorbide mononitrate can cause dizziness and lightheadedness. Get up slowly from a sitting or lying position. Avoid drinking alcohol while on this medicine, as this can make these side effects worse.

Headaches are a common and bothersome side effect of isosorbide mononitrate. If you develop a headache, it is an indication that the medicine is working. Do not change the timing of your dose to prevent headaches because this can make isosorbide mononitrate less effective. Talk to your doctor if the headaches are a problem. They may give you a pain reliever.

Call your doctor if you become pregnant while taking isosorbide mononitrate.

Tell all your doctors you are on isosorbide mononitrate, especially before any surgery, including dental procedures.

Isosorbide Mononitrate Drug Interactions

Other drugs can affect how isosorbide mononitrate works. Possible drug interactions with other medicines can increase the risk of severe adverse effects.

Before starting isosorbide mononitrate, tell your doctor if you are taking riociguat (Adempas) or medications used to treat erectile dysfunction ED called phosphodiesterase 5 inhibitors, such as sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis), avanafil (Stendra), or vardenafil (Levitra, Staxyn). It is not safe to take isosorbide if you are taking one of these drugs.

The following medications can also have interactions with isosorbide mononitrate:

Aspirin
Calcium channel blockers such as diltiazem (Cardizem, Cartia, Dilt-CD, others), nifedipine (Adalat CC, Afeditab, Procardia), felodipine (Plendil), amlodipine (Norvasc, in Amturnide, in Tekamlo), isradipine, and verapamil (Calan, Covera, Verelan)
Beta blockers such as metoprolol (Lopressor, Toprol-XL, in Dutoprol, in Lopressor HCT), atenolol (Tenormin, Tenoretic), propranolol (Hemangeol, Inderal, Innopran), labetalol (Trandate), carteolol, nadolol (Corgard, in Corzide), sotalol (Betapace, Sorine, Sotylize), and timolol
Ergot-type medications such as cabergoline, bromocriptine (Cycloset, Parlodel), dihydroergotamine (D.H.E. 45, Migranal), ergotamine (in Cafergot, in Migergot), ergoloid mesylates (Hydergine), and methylergonovine (Methergine)
Medications prescribed for cardiovascular conditions such as high blood pressure, heart failure, or irregular heart rhythm

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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