What is Imduran (Isosorbide mononitrate)?

From the Guidelines

Imduran is not mentioned in the provided guidelines, but based on the context of coronary artery disease management, it is essential to focus on the recommended pharmacotherapies for different endotypes of coronary artery function disorders. When considering the management of patients with chronic coronary disease, as outlined in the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline 1, the primary focus is on evidence-based pharmacotherapy to improve outcomes in terms of morbidity, mortality, and quality of life. For microvascular angina, the first-line antianginal therapy includes beta blockers, such as carvedilol, which can be initiated at a dose of 6.25 mg BID and uptitrated as needed 1. In cases of vasospastic angina, calcium channel blockers (CCBs) like verapamil are recommended as first-line therapy, starting with 40 mg BID and titrating as necessary 1. It's crucial to note that the management strategy should be tailored to the specific endotype of coronary artery function disorder, considering factors such as microvascular resistance, coronary vasorelaxation, and microvasodilator capacity. Regular monitoring and adjustment of pharmacotherapy are vital to optimize treatment outcomes and minimize adverse effects. Given the information provided, the most appropriate recommendation for managing coronary artery disease, based on the latest guideline evidence, prioritizes the use of evidence-based pharmacotherapies like beta blockers and CCBs, tailored to the specific disorder endotype. Key considerations in the management of these conditions include:

• Baseline therapy with aspirin, statin, and ACEi for patients with atherosclerosis or endothelial impairment
• Sublingual nitroglycerin as needed for symptom relief
• Smoking cessation and lifestyle changes to reduce cardiovascular risk
• Regular follow-up with a healthcare provider to monitor treatment response and adjust the management plan as necessary. In the context of heart failure management, as discussed in the 2022 AHA/ACC/HFSA guideline 1, the focus is on optimizing pharmacotherapy to improve outcomes, with medications such as ACEi, ARB, beta blockers, and mineralocorticoid receptor antagonists playing crucial roles. However, the primary consideration in managing coronary artery disease should be the guideline recommendations specific to coronary artery function disorders, as outlined in the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline 1.

From the FDA Drug Label

CLINICAL PHARMACOLOGY Mechanism of Action The isosorbide mononitrate extended-release tablet is an oral extended-release formulation of ISMN, the major active metabolite of isosorbide dinitrate; most of the clinical activity of the dinitrate is attributable to the mononitrate The principal pharmacological action of ISMN and all organic nitrates in general is relaxation of vascular smooth muscle, producing dilatation of peripheral arteries and veins, especially the latter Dilatation of the veins promotes peripheral pooling of blood, decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure and mean arterial pressure (afterload). Dilatation of the coronary arteries also occurs

The Imduran is an oral extended-release formulation of Isosorbide Mononitrate (ISMN), which is a vasodilator that relaxes vascular smooth muscle, producing dilatation of peripheral arteries and veins. The principal pharmacological action of ISMN is to reduce preload and afterload, and to dilate coronary arteries. 2

From the Research

Imduran Overview

• Imdur (IMD) is a sustained-release isosorbide 5-mononitrate preparation for the treatment of chronic stable angina pectoris 3
• It is designed to provide controlled medication release using the Durules principle of insoluble matrix embedding 3

Efficacy and Tolerance

• Studies have shown that Imdur 60 mg once daily has significant antianginal and anti-ischaemic effects compared with placebo after 2 weeks' treatment 3
• There is no evidence of classical tolerance to Imdur 30 to 240 mg/day in a large well-designed study 3
• Intermittent therapy with once-daily ingestion of high-dose sustained-release isosorbide dinitrate or isosorbide-5-mononitrate can prevent the development of tolerance 4

Comparative Trials

• Imdur 60 mg once daily was more effective than isosorbide dinitrate 30 mg 4 times daily and similar to or better than isosorbide dinitrate 20 mg 3 times daily in comparative trials lasting approximately 2 weeks 3
• Preliminary data show that Imdur 60 mg once daily has similar efficacy to diltiazem 60 mg 3 times daily and is at least as effective as certain other sustained-release isosorbide 5-mononitrate preparations 3

Safety and Tolerability

• Imdur is generally well tolerated, with the most frequently reported adverse event being headache, which is usually mild to moderate and improves with long-term therapy 3
• Patient compliance is better with once-daily administration of Imdur than with twice-daily administration of conventional isosorbide 5-mononitrate 3
• Serious adverse effects were observed in 2% of patients treated with isosorbide-5-mononitrate, and 6.4% of patients discontinued treatment due to inefficacy, infarction, death, or adverse effects 5

Clinical Studies

• A multicenter study in general practice found that isosorbide-5-mononitrate reduced the frequency of anginal attacks by 83% and nitroglycerin consumption by 85.7% in patients with coronary artery disease and chronic stable angina pectoris 5
• A clinical study found that an intravenous drip of isosorbide mononitrate was an effective treatment for angina pectoris in coronary heart disease, with fewer adverse reactions and higher safety compared to glyceryl trinitrate 6