What is the use of Imdur (Isosorbide mononitrate) for Takotsubo (Stress) cardiomyopathy?

From the Guidelines

Imdur (isosorbide mononitrate) is not typically a first-line treatment for Takotsubo cardiomyopathy, also known as stress cardiomyopathy or broken heart syndrome. The management of Takotsubo cardiomyopathy generally focuses on supportive care and treating the underlying cause, as the condition often resolves on its own within days to weeks. Standard treatment usually includes beta-blockers like metoprolol or carvedilol to reduce heart workload, and ACE inhibitors like lisinopril or enalapril to help with cardiac remodeling 1. Imdur, being a nitrate medication, works by dilating blood vessels and reducing the workload on the heart, which could potentially help with symptoms like chest pain in some Takotsubo patients. However, it's not specifically indicated for this condition and would only be used if there were specific reasons such as ongoing angina symptoms or concurrent coronary artery disease.

Some key points to consider in the management of Takotsubo cardiomyopathy include:

• The use of beta-blockers and ACE inhibitors as standard treatment 1
• The potential use of anticoagulant therapy for left ventricular thrombi 1
• The consideration of prophylactic anticoagulation to prevent left ventricular thrombi 1
• The importance of individualizing treatment decisions based on the patient's presentation and hemodynamic status 1

The typical dose of Imdur for cardiac conditions ranges from 30-120 mg once daily, but any use in Takotsubo should be determined by a cardiologist based on the individual patient's presentation and hemodynamic status. According to the most recent guidelines, the use of nitrates such as Imdur may be considered as a second-line treatment option for patients with chronic coronary syndromes who have not responded to first-line treatments 1. Treatment decisions should be individualized as Takotsubo can present with varying degrees of heart failure and hemodynamic compromise.

From the Research

Imdur for Takutsobo

• Imdur is a sustained-release isosorbide 5-mononitrate preparation used for the treatment of chronic stable angina pectoris 2.
• The medication has significant antianginal and anti-ischaemic effects compared to placebo after 2 weeks of treatment 2.
• Imdur 60 mg once daily is the most widely studied dosage and has been shown to be effective in providing prophylaxis of symptoms throughout the day 2, 3.

Efficacy and Tolerance

• Studies have found no evidence of classical tolerance to Imdur 30 to 240 mg/day 2.
• Imdur 60 mg once daily has been shown to be more effective than isosorbide dinitrate 30 mg 4 times daily and similar to or better than isosorbide dinitrate 20 mg 3 times daily 2.
• Preliminary data suggest that Imdur 60 mg once daily has similar efficacy to diltiazem 60 mg 3 times daily 2.

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 2, 3.
• Patient compliance is better with once-daily administration of Imdur than with twice-daily administration of conventional isosorbide 5-mononitrate 2.
• Abrupt discontinuation of Imdur during long-term treatment may exacerbate anginal symptoms 2.