From the Guidelines
The most appropriate alternative to isosorbide mononitrate is hydralazine, as the combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV HFrEF on GDMT, and hydralazine can be useful in patients with HFrEF who cannot be given ACE inhibitors or ARBs 1. When considering alternatives to isosorbide mononitrate, it's essential to understand that isosorbide mononitrate is a nitrate medication typically prescribed for angina (chest pain) caused by coronary artery disease.
- The patient's medical history and the reason for taking isosorbide mononitrate must be considered before recommending an alternative medication.
- Other medications, such as ACE inhibitors, ARBs, beta-blockers, and aldosterone receptor antagonists, may be recommended for patients with heart failure, but they work differently and have different side effect profiles 1.
- Never stop taking isosorbide mononitrate suddenly, as this can cause a dangerous rebound effect with worsening chest pain.
- It's crucial to consult with a doctor or cardiologist before making any changes to a heart medication regimen, as they can evaluate specific needs and recommend an appropriate alternative if necessary. Some key points to consider when evaluating alternatives to isosorbide mononitrate include:
- The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV HFrEF on GDMT 1.
- A combination of hydralazine and isosorbide dinitrate can be useful in patients with HFrEF who cannot be given ACE inhibitors or ARBs 1.
- Digoxin can be beneficial in patients with HFrEF, but its use should be individualized 1.
- Omega-3 PUFA supplementation is reasonable to use as adjunctive therapy in HFrEF or HFpEF patients 1.
From the Research
Alternatives to Isosorbide Mononitrate
- Other nitrates such as nitroglycerin and isosorbide dinitrate can be used as alternatives to isosorbide mononitrate 2, 3
- Calcium-channel blockers and beta blockers can also be used to treat angina pectoris, although they work through different mechanisms than nitrates 2
- Specific alternatives include:
- Diltiazem, which has been shown to have similar efficacy to isosorbide 5-mononitrate in some studies 4
- Hydralazine, which can be used in combination with isosorbide dinitrate to treat heart failure 3
- Other sustained-release isosorbide 5-mononitrate preparations, which may have similar efficacy to Imdur 4
Comparison of Alternatives
- Isosorbide dinitrate and isosorbide 5-mononitrate have been compared in several studies, with some showing similar efficacy and others showing greater therapeutic benefits with isosorbide 5-mononitrate 5, 6
- The choice of alternative will depend on individual patient needs and responses to different medications 3, 4