From the Guidelines
Imdur ER (isosorbide mononitrate extended-release) should be used at a typical starting dose of 30-60 mg once daily, taken in the morning, to prevent angina in patients with coronary artery disease, as recommended by the most recent guidelines 1.
Key Considerations
- Imdur ER works by relaxing blood vessels, improving blood flow to the heart muscle, and reducing the workload on the heart.
- To prevent tolerance development, a nitrate-free period of 10-14 hours daily is recommended, which is why it's usually taken in the morning.
- Common side effects include headache, dizziness, and lightheadedness, especially when starting treatment.
- Patients should avoid taking erectile dysfunction medications like sildenafil (Viagra) while using Imdur ER as this combination can cause dangerous drops in blood pressure.
- Alcohol should also be avoided as it can enhance the blood pressure-lowering effects.
- Patients should take Imdur ER on an empty stomach, at least 30 minutes before or 2 hours after meals, and swallow the tablets whole without crushing or chewing them to maintain the extended-release properties.
Dosage and Administration
- The dose can be increased to a maximum of 120 mg daily if needed, as per the guidelines 1.
- The medication should be taken as directed by the healthcare provider, and any changes to the dosage or administration should be made under their guidance.
Important Interactions and Precautions
- Imdur ER can interact with other medications, such as beta blockers and calcium channel blockers, and patients should inform their healthcare provider about all medications they are taking.
- Patients with certain medical conditions, such as hypotension or heart failure, should use Imdur ER with caution and under close medical supervision.
- Regular monitoring of blood pressure and heart rate is recommended while taking Imdur ER.
From the FDA Drug Label
Isosorbide mononitrate extended-release tablets are indicated for the prevention of angina pectoris due to coronary artery disease. The onset of action of oral isosorbide mononitrate is not sufficiently rapid for this product to be useful in aborting an acute anginal episode.
The Imdur ER is used for the prevention of angina pectoris, but it is not suitable for aborting an acute anginal episode due to its slow onset of action 2.
- Key points:
- Indication: Prevention of angina pectoris
- Onset of action: Not rapid enough to abort an acute anginal episode
- Clinical decision: Imdur ER should be used for prevention, not treatment, of angina attacks. 2
From the Research
Imdur ER Overview
- Imdur ER 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 Safety
- Studies have shown that Imdur ER 60 mg once daily has significant antianginal and anti-ischaemic effects compared with placebo after 2 weeks' treatment 3
- Imdur ER has been found to be effective in reducing the frequency of anginal attacks and nitroglycerin consumption in patients with coronary artery disease and chronic stable angina pectoris 4
- The most frequently reported adverse event is headache, which is usually mild to moderate and improves with long-term therapy 3
- Treatment-related adverse events were reported in 37% of patients in the Imdur ER group, with headache being the most common 5
Dosage and Administration
- Imdur ER 60 mg once daily has been shown to provide effective antianginal prophylaxis for up to 12 hours 3
- A daily low-nitrate interval is required to prevent tolerance development, and a 12-h patch-free interval should prevent tolerance in most patients 6
- Imdur ER can be administered once daily, which improves patient compliance compared to twice-daily administration of conventional isosorbide 5-mononitrate 3