Monosan tabs 20mg #30

Monosan instruction

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Monosan is a peripheral vasodilator with a predominant effect on venous vessels, an antianginal agent.

Release form and composition

Dosage form - tablets: flat, round, almost white or white, on one side of the risk (10 tablets in blisters, 3 blisters in a cardboard box).
Active ingredient: isosorbide-5-mononitrate, its content in 1 tablet is 20 or 40 mg.
Additional components: microcrystalline cellulose, granular lactose, corn starch, talc, magnesium stearate.

Pharmacodynamics

Monosan is a drug that has a vasodilator, antianginal, arteriodilatory and hypotensive effect.
The active ingredient of Monosan is isosorbide mononitrate, a peripheral vasodilator that mainly affects the venous vessels. In the vascular endothelium, it stimulates the formation of nitric oxide (an endothelial relaxing factor), which causes the activation of intracellular guanylate cyclase, as a result of which the mediator of vasodilation, cyclic guanosine monophosphate (cGMP), increases.
Isosorbide mononitrate reduces pre- and afterload, reducing myocardial oxygen demand. Possesses coronary dilating properties. Reduces blood flow to the right atrium and pressure in the pulmonary circulation, promotes redistribution of coronary blood flow in areas with reduced blood circulation, as well as regression of symptoms in pulmonary edema.
With angina pectoris and coronary heart disease, it increases exercise tolerance. Expands the vessels of the brain and dura mater, which can lead to headaches. Reduces intra-platelet synthesis of Tx, inhibits platelet aggregation.
As with other nitrates, cross-tolerance develops to isosorbide mononitrate. After the cancellation of Monosan (including after a temporary break in treatment), the body's sensitivity to the drug is quickly restored.
The antianginal effect develops within 30–45 minutes after taking Monosan and lasts for 8–10 hours.

Pharmacokinetics

After oral administration of isosorbide, mononitrate is completely and rapidly absorbed from the gastrointestinal tract.
The drug does not have the effect of the first passage through the liver, therefore it is characterized by a very high bioavailability - about 100%. Does not bind to blood plasma proteins.
The maximum concentration in the blood reaches within 1 hour. Individual differences in patients do not significantly affect plasma concentrations. The effective blood level of isosorbide mononitrate is approximately 100 mg / ml.
When using Monosan in the dose range from 10 to 80 mg, the pharmacokinetics are linear. Unlike isosorbide dinitrate, isosorbide mononitrate is metabolized not in the liver, but in the kidneys to form isosorbide and two glucuronides isosorbide-5-mononitrate.
It is excreted by the kidneys mainly in the form of glucuronic metabolites, unchanged - no more than 2%. The half-life is 4-5 hours. Renal clearance - 115 ml / min. In hepatocellular and renal failure, the pharmacokinetic parameters of the drug do not change significantly.

Indications for use

Combination therapy:
    Chronic heart failure;
    Pulmonary heart;
    Pulmonary hypertension.
Monosan is also used to prevent angina attacks in patients with coronary heart disease.

Contraindications

    Cardiac tamponade;
    Left ventricular failure with low diastolic pressure;
    Arterial hypotension and arterial hypovolemia (systolic blood pressure below 100 mm Hg, diastolic blood pressure below 60 mm Hg, central venous pressure below 4-5 mm Hg);
    Acute myocardial infarction, accompanied by severe arterial hypotension;
    Angle-closure glaucoma;
    Vascular collapse;
    Shock;
    Diseases accompanied by increased intracranial pressure (including hemorrhagic stroke, as well as traumatic brain injury);
    Toxic pulmonary edema;
    Age under 18;
    Hypersensitivity to the drug or other nitrates.
According to the instructions, according to indications, Monosan should be used with extreme caution in the following cases:
    Aortic and / or mitral stenosis;
    Tendency to orthostatic disorders of vascular regulation;
    Hypertrophic cardiomyopathy;
    Constrictive pericarditis;
    Severe renal failure;
    Liver failure;
    Severe anemia;
    Thyrotoxicosis;
    Pregnancy and lactation;
    Elderly age.

Instructions for use: method and dosage

Monosan should be taken orally after meals: swallow the tablets whole and drink them with a sufficient amount of liquid.
The doctor sets the optimal dose individually for the patient, depending on the severity of the disease.
At the beginning of therapy, usually 10-20 mg is prescribed 1 to 3 times a day. If the therapeutic effect is insufficient, from the 3-5th day of treatment, the pink dose is increased to 40-60 mg.
The highest permitted daily dose is 80 mg.

Side effects

    Allergic reactions: skin rash; in rare cases - exfoliative dermatitis;
    From the side of the central nervous system: blurred vision, drowsiness, stiffness, decreased speed of mental and motor reactions (especially at the beginning of treatment); in rare cases - cerebral ischemia;
    From the digestive system: a slight burning sensation of the tongue, dry mouth, nausea and / or vomiting;
    From the side of the cardiovascular system: transient hyperemia of the skin of the face, "nitrate" headache, vertigo, a marked decrease in blood pressure, a feeling of heat, tachycardia; in rare cases - orthostatic collapse, paradoxical intensification of angina attacks;
    Others: tolerance, including cross-tolerance to other nitrates.

Overdose

Overdose symptoms: hyperthermia, increased sweating, skin redness, weakness, headache, lethargy, dizziness, visual disturbances, diarrhea, nausea, vomiting, reflex tachycardia, fainting, collapse, increased intracranial pressure, dyspnoea, hypoderpnoea, ; more often in case of chronic overdose), convulsions, paralysis, coma.
First of all, the usual first aid measures are taken: they do the gastric lavage, the patient is placed in a horizontal position and the legs are raised. The indicators of vital functions of the body should be monitored and adjusted if necessary. With severe arterial hypotension and / or shock, the replenishment of the circulating blood volume is indicated. In exceptional cases, norepinephrine and / or dopamine are administered to improve blood circulation. The administration of adrenaline (epinephrine) and related compounds is contraindicated. With methemoglobinemia, depending on its severity, ascorbic acid is prescribed in the form of sodium salt intravenously, hemodialysis, oxygen therapy, exchange blood transfusion.

Special instructions

Monosan is not intended to relieve angina attacks.
Blood pressure and heart rate should be monitored during treatment.
Patients with arterial hypertension should be prescribed Monosan in combination with drugs with a positive inotropic effect.
In the case of frequent intake and / or use of high doses of the drug, the development of tolerance is possible. If this happens, after 3-6 weeks of treatment, it is recommended to temporarily (for 24-48 hours) cancellation of Monosan or a break in therapy for 3-5 days with the replacement of isosorbide-5-mononitrate at this time with another antianginal agent.
It is not recommended to abruptly cancel the drug, you should gradually reduce its dose.

Influence on the ability to drive vehicles and complex mechanisms

Since the drug can affect the rate of psychophysical reactions, care must be taken when driving a car and working in potentially hazardous industries.

Application during pregnancy and lactation

The data on the use of isosorbide mononitrate in pregnant and lactating women are not enough to establish the degree of its safety, therefore, Monosan during pregnancy and lactation can only be used as directed by a doctor, who must first assess the ratio of benefits to the woman and possible risks to the fetus / child. Children whose mothers take the drug during breastfeeding should be under constant medical supervision in order to identify the possible development of side effects in time.

Childhood use

Monosan is contraindicated for the treatment of children and adolescents under the age of 18.

With impaired renal function

In severe renal failure, Monosan should be used with caution.

For violations of liver function

In patients with concomitant hepatic insufficiency, the risk of developing methemoglobinemia is increased, therefore, Monosan, if indicated, should be taken with caution, under the supervision of the attending physician.

Use in the elderly

Monosan should be used with caution in old age.

Drug interactions

    Dihydroergotamine: its concentration in blood plasma increases;
    Barbiturates: biotransformation is accelerated and the concentration of isosorbide-5-mononitrate in the blood decreases;
    Antihypertensive drugs, peripheral vasodilators, tricyclic antidepressants, antipsychotics, slow calcium channel blockers, beta-blockers, quinidine, sildenafil, novocainamide, dihydroergotamine, ethanol: increased hypotensive effect;
    Slow calcium channel blockers, propranolol, amiodarone, acetylsalicylic acid: the antianginal effect is enhanced;
    Alpha-blockers, beta-adrenostimulants: the severity of the antianginal action of Monosan decreases, as a result of which an excessive decrease in blood pressure and the development of tachycardia are possible;
    M-anticholinergics (for example, atropine): the risk of increased intraocular pressure increases;
    Adsorbents, coating and astringent preparations: the absorption of isosorbide-5-mononitrate from the gastrointestinal tract is reduced.

Terms and conditions of storage

Store at a temperature of 15 to 25 ºС out of the reach of children, dry and protected from light.
Shelf life is 4 years.

Reviews

Reviews about Monosan are positive. Patients note that the drug significantly reduces the frequency of angina attacks and increases exercise tolerance, as a result of which shortness of breath decreases, the feeling of lack of air disappears, and the quality of life improves. Monosan is well tolerated and rarely causes side effects.

Terms of sell

You can buy Monosan without a prescription.