Diagnosis of vasospastic angina in 2018. Finally saw a consultant properly by going private in December 2024. He prescribed 60mg Diltiazem. That was a disaster. Within a week, I was unable to function.
At review last week, the consultant advised that because of that experience, calcium channel blockers are a no no and he has now prescribed isosorbide mononitrate 30mg to be taken at night.
I had a call from the pharmacist at the GP surgery yesterday telling me that as they don't make 30mg tablets, they will have to prescribe 60mg, but it's all right because there is a score line on the tablets so I can cut them in half myself! However, according to the BNF, 30mg tablets are available.
What on earth is going on here? Is it a cost issue?
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AngelRain
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There has been an ongoing problem of supply issues with various medications for several years. It's a worldwide issue.
Sometimes it's Diltiazem, nicorandil or isosorbide mononitrate.
My prescription is written so my Pharmacist can dispense whatever brand of Isosorbide mononitrate is available.
I have been on isosorbide mononitrate for over 10 years. I have always been dispensed with 60mgs tablet which I break in half if necessary.
I started on 30mgs and now take 60mgs at 6pm and 11pm.
In the summer I reduce my dose.
I also use nitrate patches.
A common side affect of taking nitrates is a headache which can take about 2 weeks to settle.
I founnd drinking lots of water and taking paracetamol got me through the headache. Check with your Pharmacist to say it's okay for you to take paracetamol.
I hope the isosorbide mononitrate helps you.
There are other possible medications that can help manage vasospastic angina.
I had a myocardial perfusion scan in 2018. I had a massive reaction to the drug used, but the scan itself was clear. There has been some talk of a provocative angiogram, but nothing definite.
I couldn't recite my DOB, name, address etc. They blamed it on me having caffeine before the test and told me off, but I hadn't had caffeine for 36 years!
Hello MilkFairy, May I ask how many days the nausea and headache last with isosorbide? I am on the 2nd day of 10mg to reduce dyspnea, but symptomps are hardcore.. thanks!!
I have always been given 60mg tablets Luckily ,when I was first put on on them and had not to take 30mg i was,given a,very good pill cutter by the hospital pharmacy. You can buy one from a,pharmacy.
Sorry to hear of your experience. Just my two penn'orth - started with Isosorbide Mononitrate 50mg slow release (1 each morning) since angina first diagnosed Dec 2022. Touch wood - my pharmacist has not had supply issues - the brand is Elantan. No ill effects. Good luck with everything
I’ve been on them for a couple of years now and have only ever been told to break the 60mg ones in half. I got a pill cutter from Amazon that does a good job. Apparently although I have chest pain whilst in atrial fibrillation, I don’t have angina, but the Isosorbide Mononitrate stops the pain whilst also lowering my blood pressure and reducing the pressure in my eyes which helps my glaucoma. I’ve never had a problem getting them.
I was on 30 and had to break the tablets - they were easy to do - just put them on a hard surface and press each end of the oval tablet. They snap easily. Be ready for headaches when you start, paracetamol help, and the fade away in a couple of weeks
I am also on isorbide mononitrate, prescribed dose of 10 mg morning and night, for two months these have not been available at the chemist. After missing tablets for 4 days the doctor prescribed 25mg slow release. I had an awful few days on the swap over. I don’t know which prescription I will get next month. It appears there are a lack of supply for this tablet. Hope you get sorted soon.
Oh joy! So I may not have vasospastic angina at all? Is that what you're saying?
The diagnosis was the main reason I was managed out of my job (because I needed reasonable adjustments), it is the reason I can't go abroad (because travel insurance is prohibitive) etc etc
However it's worth asking for appropriate testing to determine whether your angina/ ischaemia without obstructive coronary arteries, ANOCA/INOCA is due to microvascular dysfunction or coronary vasospasms.
The CorMicA research suggests having a correct diagnosis guides the medical staff how to treat patients symptoms better.
It also improves the quality of life for people living with microvascular or vasospastic angina.
I do have some concerns about my diagnosis to be fair. At present, despite being unmedicated, I have an acute episode only every 5/6 weeks, I have never been to A&E, never been admitted, my GP surgery attach no importance to my diagnosis at all and so it goes on. I am due to see an NHS cardiologist in July. Maybe I should ask some questions.
hi there. There is a national shortage I’m on 30mg, 20mg morning and 10mg late afternoon. My prescription wasn’t even filled. They left me high and dry. So I had to do phoning around until I found a pharmacy with a supply. Had to phone doctors to get a new script even then they only gave me half I needed.
They definitely do a 20mg and 10mg so ask if you can have that instead. But they are also in short supply
I had the same problem. Apparently the company who manufactured this medication who were based in Wales United kingdom has closed and moved to the United States. It's not cost I'm told but availability. It's true the Isosorbide do have a score line so you are able to halve. 🤗
I have had 30 mg tablets in the past but am on 60 mg now and have been for some time. I came off the tablets completely at one point but after five days I had a series of coronary spasms which resulted in me going back on the 60 mg. They allow me to do whatever exercise I want to but you must remember that they cannot be taken in combination with certain other drugs. Check with your GP
There's a caution for hypothyroidism (I've been on Levothyroxine sine 2013) but I can'r find anything online about the reason for this and the consultant did not seem concerned.
Various meds are harder to come by. My Nicorandil brand was changed and I ended up on the verge of another trip to A&E with spasms. Doc and chemist put on notes to only give me Zentiva brand now as anything else isn't great. It's surprising how much the difference in manufacturing can affect those with spasms apparently. Even my son's diabetic meds are becoming harder to get.
Hopefully the Isosorbide works for you.
If it doesn't I'd ask about Ranolazine or Nicorandil. Both together have been very helpful.
Try to avoid stress and extremes of temp too. That can set it off hugely.
Hi AngelRain, I am so pleased that Isosorbide Mononitrate 30mg is helping. If the pharmacist unable to dispense 30mg strength , you can go to another pharmacy and try . If it's manufacturing problem, then it's out of stock and not available. However if you get any break through pain, you can use GTN spray under the tongue but be careful, you may experience headache . Hope this small advice helps. Regards.
I have just collected the prescription. Apparently 30mg is not available at the moment. I have 60mg modified release tablets, dispensed as "Take half a tablet (30mg) daily" "Swallow whole do not chew or crush" Well, I can't swallow whole if I've had to split it in two, can I?
when I was first put onto it I was told the same..1/2 of a 60g tablet. I broke them in half and was quite poorly for several days. I rang my GP who then gave me a lesser dose for two weeks then the full dose. They are slow release and I don’t think that snapping them in half is good for you.
Absolutely no probs on a lesser tablet to start with for two wks ( 30g I think) and I’ve been ok and thankful for them ever since and that’s a few yrs now,
II was diagnosed with Angina 3 years ago and put on 40 mg Isosorbide twice /day.They gave me problems so it was later changed to 10mg twice/day.Then I had problems getting them due to supply issues.I am now on Tardisc XL (this is a brand of Isosorbide) and I have to just take a half in the morning.The tablets are scored in the midle whic makes them easy to cut.
The new tablets seem to be ok except I have occasionially been having very mild headaches on the front of my head whch started just after the change of tablets.When I next see my GP I will ask if they are the cause of these headaches.
Do you feel you may have microvascular or vasospastic angina?
My diagnosis of vasospastic angina was confirmed by a functional angiogram using a chemical acetylcholine.The BHF website has this information about vasospastic angina
I was originally presumed to have microvascular angina by exclusion. As a result I was prescribed medication that made my coronary vasospasms much worse. I ended up in hospital on CCU with unstable angina.
Here's some information about microvascular angina
At present I am on 30mg Isosorbide Mononitrate for Angina .
I have had to have 10mg tablets (3x) once daily and any pharmacist worth their weight in salt would have recommended this as this is not only a patient compliance issue and also a laziness issue with pharmacist for not sorting out 10mg tablets to be prescribed or even cuting the 60mg in half themselves.
I worked within pharmaceuticals for 14 years and cut tablets, asked GP's to change prescription,doses and frequencies so there is no excuses.
I would recommend to change to a different pharmacy if their aren't prepared to help you..
Unfortunately it comes down to cost and pharmaceutical companies will stop or discontinue medication randomly if they are not making enough money on them, can make more money on multiple doses or higher doses.
It is nothing to do with raw ingredient issues as if that was the case you would have no drugs preparations manufactured.
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Isosorbide mononitrate
Isosorbide Mononitrate 
Isosorbide mononitrate
