From the Guidelines
Imdur (isosorbide mononitrate) is contraindicated in patients with severe hypotension, hypertrophic cardiomyopathy, constrictive pericarditis, cardiac tamponade, and those taking phosphodiesterase-5 inhibitors like sildenafil, tadalafil, or vardenafil, due to the risk of severe hypotension and potential mortality 1.
Key Contraindications
- Hypersensitivity to nitrates or isosorbide mononitrate
- Severe hypotension (low blood pressure)
- Hypertrophic cardiomyopathy
- Constrictive pericarditis
- Cardiac tamponade
- Concurrent use of phosphodiesterase-5 inhibitors like sildenafil, tadalafil, or vardenafil
Important Considerations
- Imdur should be used cautiously in patients with volume depletion, those taking antihypertensive medications, and patients with angle-closure glaucoma
- Caution is also warranted in patients with severe renal or hepatic impairment
- The medication works by dilating blood vessels, which can dangerously lower blood pressure in vulnerable patients or when combined with certain medications that have similar effects on blood pressure
Clinical Guidelines
- According to the 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes, nitrates are not recommended in patients with hypertrophic obstructive cardiomyopathy or co-administration of phosphodiesterase inhibitors 1
- The guidelines also recommend that long-acting nitrates should be considered as a second-line treatment option when initial therapy with a beta-blocker and/or a non-DHP-CCB is contraindicated, poorly tolerated, or inadequate to control angina symptoms 1
From the FDA Drug Label
Isosorbide mononitrate extended-release tablets are contraindicated in patients who have shown hypersensitivity or idiosyncratic reactions to other nitrates or nitrites. The contraindications for Imdur (isosorbide mononitrate) are:
- Hypersensitivity or idiosyncratic reactions to other nitrates or nitrites 2
From the Research
Contraindications for Imdur
- The provided studies do not directly address contraindications for Imdur, which is another name for isosorbide mononitrate, a medication used to prevent angina attacks.
- However, based on the information provided in the studies, potential contraindications or precautions for the use of isosorbide mononitrate or similar nitrates can be inferred:
- Severe hypotension or bradycardia, as seen in some patients with acute myocardial infarction who received sublingual isosorbide dinitrate 3.
- Patients with certain types of myocardial infarction, such as those with marked ST segment elevation, may experience a deleterious effect from isosorbide dinitrate 4.
- Caution should be exercised when using nitrates in patients with acute myocardial infarction, especially if they have low blood pressure or are at risk for hypotension 3, 4.
- Patients with severe left ventricular failure or those who are hypovolemic may be at increased risk for adverse effects from nitrates 5.
- It is essential to carefully evaluate the patient's condition and medical history before administering isosorbide mononitrate or any other nitrate medication, and to monitor them closely for potential adverse effects 6, 7, 5.