Monomil XL dosage?

[Cruise1]

Diagnosed with stable angina over 3 weeks ago and prescribed 30 mg Monomil XL per day. Reading the blurb with the medication it says to take 30 mg for first 3 to 4 days then increase to 60 mg. anyone else taking it? Tried phoning doc a couple of times but not getting connected, Tending to use GTN spray before embarking on anything. Had pain whilst light vacuuming and straightening bed and drawing back curtains.

[MichaelJH Heart Star]

Monomil XL is an extended release version of the anti-anginal Isosorbide Mononitrate of which there are over half a dozen brands. One usually tends to start on a lower dose as headaches and dizziness sometimes occur when starting the medication. This dose is then increased if the angina persists. As you are using GTN spray frequently this seems entirely appropriate for you. If you cannot speak to your doctor ring 111. I only had GTN spray once while on anti-anginals (other types are available). Good luck.

[benjijen]

I'm on Monomil and it was reduced by half earlier this year. It was soon put back up to 60mg per day as my unstable angina became considerably worse again. It's fairly settled again now. You need to speak with cardiologist or GP.

[Cruise1 in reply to benjijen]

Have spoken to GP today who has reluctantly increased dose but not taken off blood pressure meds despite considerably lower blood pressure readings I have taken since being on the Monomil XL. My angina is supposed to be stable But was diagnosed after emergency admission to hospital and discharged the following day with no follow up appointment given yet mention of angiogram which I am trying to arrange privately as there is a long waiting list.

[benjijen in reply to Cruise1]

I had what they classed as a 'non urgent' angiogram as well. As they said I would need 3 stents they weren't done at the time. I didn't want surgery and in the end I went in again and had 2 stents fitted. If you can go privately then that's a good idea and hopefully, if you need stents, they will do them there and then. Good luck.

[Cruise1 in reply to benjijen]

Unfortunate it appears that if I need stents it would be done at a different time as any procedures would be an increased price and need extra staff on standby just in case.

[Mallowme in reply to Cruise1]

Sorry I missed a couple of these posts and they have just appeared so have repeated some stuff.

I think there’s a few glitches on here at the mo. Can I ask, is your lower blood pressure causing you problems as that could be why they don’t want to up the Monomil further.

[Mallowme]

Hi Cruise1.

I’m taking Monomil 60mg in the morning.

The reason they don’t like upping the dose is that you can become tolerant to it so they like to keep the dose as low as possible. If it does need to be higher they like to do it slowly because of the awful headache it gives you at the start.

This is a slow release nitrate lasting about 10hrs so you have a ‘nitrate free period’ to help combat this.

If you are still having to use your gtn spray often then there could be a reason to up the dose, which you would need to discuss with your doctor. If 30mg is working then it doesn’t have to go up.

For me 60mg still wasn’t enough and there were discussions as to whether it should go up to 120mg but as I was having a lot of angina pain in the evening and during the night as well and I am unable to take beta blockers I have been put on Nicorandil morning and evening as well and finally it seems to be helping.

Keep phoning your doctor if your medication isn’t helping as they can keep tweaking it or changing it until you are on the best option for you.

By the way if you are able to, sign up at your surgery for a web account. This is easy and you just have to fill out a form and they give you an id etc. This means you can log in and book a telephone appointment online with the doctor of your choice. I happened to have done it before Covid and it’s the best thing I ever did as never have a problem getting an appointment or sorting prescriptions etc.

[Cruise1 in reply to Mallowme]

They are not booking telephone appointments on our online doctors website. We have to phone up and wait in a long queue to make appointments and after a long wait sometimes told - we cannot take your call just now - try again later! Lower blood pressure is not causing any problems but as it’s going down I need to keep an eye on it so it doesn’t cause dizziness etc.Already fed up of the whole thing.

[Mallowme in reply to Cruise1]

It’s a slow process and patience and long suffering are qualities we learn with these conditions.

It’s frustrating that you can’t book online. It used to drive me nuts before Covid trying to get a doctors appointment- even private can be problematic. I need a cardiac pulmonary exercise stress test and NHS said because of the risk of Covid (breathing into the machine) they are only doing two a WEEK! Only severe emergencies are being given the test so I haven’t a hope. When I tried to pursue a private test I was told the specialist machines are often ‘rented’ by the private sector so it probably wasn’t going to get me any closer.

I’m sorry you’re struggling and hope things get a little easier soon. X

[Cruise1]

At least today was better. Doubled my daily walk to 0.7 miles and exercise bike for 25 mins without any twinges. Hope it’s as the result of increased dosage. I had my private angiogram booked for 24th Dec only to be told last week, just before self isolating that they couldn’t get a team together and they would get back to me with another date. This was to take place at our local hospital very early morning prior to NHS patients. Presumably the unit will not be in use at all that day! What a waste of resources and no wonder there are long waiting lists.Having been misdiagnosed on 2 occasions and nearly died twice as a result of surgical delays(not heart related ) by the same hospital, I have little faith in ‘experts’.

[Mallowme]

Wow! It comes to something when you can’t even pay to have tests. A very sad sign of the times we live in. Try to enjoy the good days. Xx