Couple of questions about isosorbide ... - British Heart Fou...

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Couple of questions about isosorbide mononitrate modified release

dunestar profile image
4 Replies

As I understand it (from the NICE guidelines) you have to have a period of downtime from the effects of isosorbide mononitrate or else you can become intolerant to it. You should only take it once a day. I take 30mg each morning. But as it lasts only about 10 hours then there's a long time during the night when the tank is empty. Is that your understanding or have I got it wrong?

Why I ask is that I'm getting funny symptoms at night - very hot and sweaty and a weird tingling/pins and needles effect in waves across my lower back. I'm wondering if it's the effect of withdrawal of the iso.

If it is right that you have to have a "rest period" then are there ways to bridge the gap with other medications? At the moment I'm taking ramipril and a statin, but both in the morning as well so any effect during the night is probably low to non-existant.

Got an appointment with the GP shortly but have waited 2 months so want to make the most of the opportunity. Any thoughts would be very welcome.

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MichaelJH profile image
MichaelJHHeart Star

This is a tricky one. If the angina is long term than intolerance can become an issue. My dose was split (and upped) for a short period prior to surgery - if surgery is but planned in the short term this is not an option. If you are not in a beta blocker a calcium channel blocker like diltiazem could be tried. I found it very effective against angina but unfortunately it made me nauseous. Speak to your GP and if he seems unclear speak to your cardiologist. Good luck in relieving the symptoms!

dunestar profile image
dunestar in reply to MichaelJH

Thank you Michael for your very helpful reply. I'll certainly see what the GP has to say as a first step.

Milkfairy profile image
MilkfairyHeart Star

Hi Dunestar

There is a big debate in the Microvascular and vasospastic angina world about whether we develop tolerance in the same way as those taking nitrates due to Coronary heart disease.

I do ensure I have a break.

As I have most of my spasms in the evenings and in the night in the winter I take 60mgs Isosorbide mononitrate extended release tablets at 6pm apply 2 10mgs GTN patches, take another 60mgs at night.

I was encouraged to experiment by a Prof to find the best time to take my nitrates. I suggest you contact your Cardiologist and seek his opinion.

In the summer as I have fewer spasms I cut down on my nitrates and try to manage whole 24 hours without any nitrates at all. I just take 30mgs tablet in the summer.

I continue with my 2 calcium channel blockers unchanged throughout the year.

I hope this helps!

dunestar profile image
dunestar in reply to Milkfairy

Thanks so much Milkfairy. This is very helpful. I think I must get out of the mindset of thinking isosorbide is my saviour and that I can't do without it. More flexibility needed!

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