isosorbide mononitrate vs dinitrate conversion
After several days, dosage may be increased to 120 mg (given as single 120-mg tablet or two 60-mg tablets) once daily. They differ from each other according to their applications and . How does isosorbide mononitrate and dinitrate work? Next review due: 1 July 2024, Isosorbide mononitrate and isosorbide dinitrate. Multiple health care professionals such as cardiologists, general practitioners, nurses, pharmacists, home care workers, and dieticians can work together to overcome these challenges of isosorbide therapy. Talk to your doctor if you're not sure it's safe for you to exercise. This medicine is not suitable for some people. Talk to your doctor if you are having problems with your sex life. Isosorbide Mononitrate Tablets 10 mg - Summary of Product - medicines ~}xp%0Vg^r3WT_a-~qvQD]dvo{,Z@${ssJC j(2GW`_? How does isosorbide dinitrate work? If you are trying to get pregnant, talk to your doctor. Nurses and general practitioners should ensure that isosorbide therapy is not an option for patients with erectile dysfunction by taking phosphodiesterase (PDE) inhibitors. Isosorbide mononitrate comes as standard tablets and slow-release (modified release) tablets and capsules. Advise patients of the likelihood of headache, particularly with initial nitrate therapy. The patient should be sitting immediately after sublingual or intrabuccal administration. Risk of elevated blood concentrations of isosorbide dinitrate in patients with cirrhosis. It is in the nitrate class of drugs. Nitrate dependence is possible (documented in daily industrial exposures); withdrawal manifestations (e.g., ischemic symptoms, MI, sudden death) can occur. For example, if you are taking standard tablets twice a day, they may tell you to take 1 dose in the morning at 8am and the second dose in the afternoon at 2pm (leaving a gap of 6 hours between your first and second dose). [10]The MLCK, along with the unphosphorylated myosin light chain, causes the myosin head to detach from the actin component of the smooth muscle, resulting in smooth muscle relaxation and causing vasodilation. Imdur (isosorbide mononitrate) Extended Release and Ranexa (ranolazine) are indicated for the prevention of angina pectoris. Tight, light-resistant containers at 25C; may be exposed to 1530C. However, this may be hazardous in renal failure and congestive heart failure patients. Or 5 to 20 mg (mononitrate conventional tablets) b.i.d. Isosorbide mononitrate or dinitrate is not likely to affect your sex life. Nitrostat (Nitroglycerin) Relieves chest pain. This should pass after a few days. Vasodilator dosing - Straight Healthcare Komicki M, Sadowski Z, Szwed H, Kowalik I. If relief is not attained after a single dose during an acute attack, may give additional doses at 5- to 10-minute intervals; no more than 3 doses should be given in a 15- to 30-minute period. 1. Isosorbide mononitrate and dinitrate can be taken by most adults aged 18 years and above. The most common side-effect is headache. ), which permits others to distribute the work, provided that the article is not altered or used commercially. Isosorbide use requires caution in the following conditions: Generally, isosorbide does not need any monitoring. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. %&SC*U]0l TCLg&=|G==!bT=4Er R|qB^RzA-C%#^krR(Luhiy7c+>Vour]ZOf?HV Isosorbide Monograph for Professionals - Drugs.com If you have darker skin your gums or the skin around your eyes may turn blue or grey, you take too many isosorbide mononitrate or isosorbide dinitrate tablets or capsules, and you feel unwell, swelling in lower legs, ankles or feet (oedema), you are having breathing difficulties that are new or worse than usual, you get weakness in your arm, or one side of your body or face, difficulty speaking, or loss of coordination these could be signs of a stroke, your mouth (lips, tongue or gums), face or skin start to look blue or grey. Isosorbide mononitrate is the major active metabolite of isosorbide dinitrate (ISDN), and most of the clinical activity of the dinitrate is attributable to the mononitrate. Isosorbide dinitrate comes as standard tablets and slow-release tablets. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. The predominant venodilation results in decreased venous return to the heart by reducing the left ventricular end-diastolic volume, left ventricular end-diastolic pressure(preload), and the ventricular wall tension,therebyindirectly facilitating subendocardial blood flow. Identify the mechanism of action of isosorbide. [17] Isosorbide does not need dose adjustment in patients with renal and hepatic dysfunction. Less frequent administration of isosorbide dinitrate may reduce the development of tolerance to the drugs antianginal effects. Note: 0.84 mL alcohol per 100 mL solution For prevention of angina. Isosorbide Mononitrate - what is the difference between isosorbide ever had an allergic reaction to isosorbide mononitrate or isosorbide dinitrate or any other medicine, any other heart problems, including a recent heart attack, any recent brain or head injuries or problems, 10mg, taken twice a day, up to a maximum dose of 120mg, split into smaller doses, 25mg to 60mg, up to a maximum dose of 120mg, taken once a day, 40mg, taken once or twice a day, up to a maximum dose of 60mg to 80mg, taken 2 or 3 times a day, 10mg to 20mg, taken 2 to 3 times a day, or 40mg, taken twice a day, up to a maximum dose of 120mg daily, split into smaller doses, 40mg to 160mg, taken daily, up to a maximum dose of 240mg a day, split into divided doses, your mouth (lips, tongue or gums), face or skin start to look blue or grey. cGMP-cGK-I inhibits theinositol-1,4,5-trisphosphate (IP3)-dependent calcium release, decreasing the intracellular calcium. Therecommended drug-free intervals for preventing the development of tolerance for oral sustained-release isosorbide dinitrate are as follows[27]: The patients should understand the possibility of developing anginal episodes during the drug-free interval. Some medicines can affect the way isosorbide mononitrate and dinitrate works. Isosorbide Mononitrate (Oral Route) Proper Use - Mayo Clinic Isosorbide mononitrate slow-release tablets or capsules: Isosorbide dinitrate slow-release tablets: Isosorbide dinitrate immediate release tablets: Taking too much isosorbide mononitrate or dinitrate may cause your blood pressure to fall too low, making you feel sick, faint and dizzy. Usually you will take isosorbide mononitrate and dinitrate for a long time, possibly for the rest of your life. Comments Dose-related hypotension, sinus bradycardia, headache, methemoglo-binemia (rare with doses of 30 mcg/kg/ min). Isosorbide mononitrate (Monoket) is good for a specific type of chest pain (called angina), but it can cause headaches or dizziness after you take it. At therapeutic levels, it predominately dilates the venous capacitance vessels but also the coronary arteries and the arterioles. Sublingual or intrabuccal nitrates may be inadequately absorbed, with resultant decreased efficacy, in patients with dry oral mucous membranes (e.g., xerostomia). % ACCF and AHA recommend initial dosage of 2030 mg 3 or 4 times daily; give concomitantly with hydralazine hydrochloride 2550 mg 3 or 4 times daily. Nitrates | Treatment summaries | BNF | NICE Isosorbide Article - StatPearls e5;O"]rQR8ku:mw/CYux:s8ofW`KMb`! The venous hypotension and the arterial hypovolemia of isosorbide overdose can be managed clinically by: There is currently no evidence of teratogenicity or carcinogenicity potential of isosorbide.[11]. (dinitrate conventional tablets) two to three times daily. When the transdermal route is used, the patch should be left in place for 12 hours. Distribution into human body tissues and fluids has not been fully characterized. Summary Isosorbide Mononitrate vs Isosorbide Dinitrate. 5. Prophylactic management in situations likely to provoke angina attacks in patients who fail to respond to sublingual nitroglycerin: 2.55 mg of isosorbide dinitrate should be placed under the tongue approximately 15 minutes prior to engaging in such activities. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Imdur is a vasodilator and Ranexa is an anti-anginal medication. Isosorbide Mononitrate Extended-Release Tablets30 mg, 60 mg - DailyMed CAS number: 87-33-2. This is because it can lower your blood pressure too much when combined with some anaesthetics. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name, 20 mg with Hydralazine Hydrochloride 37.5 mg. AHFS DI Essentials. Isosorbide mononitrate - UpToDate Nitrates in the management of chronic coronary syndrome. Isosorbide mononitrate conventional tablets, peak: 0.51 hour. Controlled medication release is achieved using the Durules principle of insoluble matrix embedding.Data from randomised double-blind trials show that IMD 60mg once daily (the most widely studied dosage) has significant antianginal and anti-ischaemic effects compared . Isosorbide mononitrate. Brand names: Dilatrate, Imdur, Ismo, Isordil, Monoket Each dilatrate Some of the patient education strategies include educating regarding the following: Home care workers can help elderly patients prone to developing orthostatic hypotension with Home safety measures. Boden WE, Finn AV, Patel D, Peacock WF, Thadani U, Zimmerman FH. The organic nitrates are vasodilators, active on both arteries and veins. If your heart failure is directly related to drinking alcohol, you may be advised to stop completely. The elimination half-life of isosorbide dinitrate is 1 hour, while the elimination half-life of isosorbide mononitrate is 5 to 6 hours. Lincoln TM, Komalavilas P, Cornwell TL. Isosorbide mononitrate dose and side-effects info | Patient There is no information about whether isosorbide mononitrate or dinitrate passes into breast milk, but the amounts are likely to be small. Isosorbide is a medication used to treat and prevent angina pectoris in patients with coronary heart disease. The possibility of developing orthostatic hypotension in elderly patients, The possibility of developing severe hypotension when combined with Phosphodiesterase(PDE) inhibitors in male patients, The development of tolerance during chronic isosorbide therapy and drug-free intervals, The possibility of developing anginal pain during drug-free intervals. Isosorbide mononitrate extended-release tablets, peak: 34.5 hours. . Isosorbide. Changing positions slowly can help lessen dizziness. Combination of isosorbide dinitrate and hydralazine recommended by ACCF and AHA for self-identified black patients with NYHA class III or IV heart failure and reduced ejection fraction who are receiving optimal therapy with ACE inhibitors and -blockers, unless contraindicated. <>>> This is called a "nitrate low" period and is needed to make sure your medicine works properly. The key difference between isosorbide mononitrate and isosorbide dinitrate is that isosorbide mononitrate is primarily used in the management of chronic stable angina, whereas isosorbide dinitrate is recommended for heart failure.. Isosorbide mononitrate and isosorbide dinitrate are important medications for some heart diseases. By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. Isosorbide mononitrate: Uses, Interactions, Mechanism of - DrugBank Isosorbide dinitrate and mononitrate are typically given chronically to prevent angina attacks. If you take other medicines that lower blood pressure with isosorbide mononitrate and dinitrate, it can sometimes lower your blood pressure too much. Because of this decrease in the heart's workload, myocardial oxygen demand becomes reduced. Manufacturers state that selective phosphodiesterase (PDE) inhibitors (e.g., sildenafil, tadalafil, vardenafil) are contraindicated in patients receiving nitrates. Tight, light-resistant containers at room temperature (25C); do not expose to extremes in temperature. Treatment effect. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patient's requirements and response; use the smallest effective dosage. Isosorbide mononitrate is available under the following different brand names: Imdur, Monoket, and ISMO. Isosorbide dinitrate dose 30-120 mg daily in divided doses. After therapeutic doses, cardiac output may increase transiently and then decrease. Both isosorbide mononitrate and isosorbide dinitrate are broken down into nitrates in the body. With a mind rooted firmly to basic principals of chemistry and passion for ever evolving field of industrial chemistry, she is keenly interested to be a true companion for those who seek knowledge in the subject of chemistry. Several contraindications exist for the use of isosorbide. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> endobj Answers. Isosorbide mononitrate is in the class of drugs called nitrates that are used for treating and preventing angina.Other nitrates include nitroglycerin (Nitrostat, NitroQuick, Nitrolingual, Nitro-Dur and others) and isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron).Nitrates are vasodilators (dilators of blood vessels). Dhi Ubu The cGMP activates the myosin light chain phosphatase (MLCP), causing dephosphorylation of the myosin light chain. Abshagen UW. Isosorbide dinitrate structure By Vaccinationist Own work (Public Domain) via Commons Wikimedia. 2. endobj May increase dosage to 120 mg (as a single 120-mg tablet or as two 60-mg tablets) once daily after several days; 240-mg dosages rarely needed. Contact dermatitis occurs in up to 40% of patients using transdermal Chewable tablet: 5-10 mg every 2-3 hours. At present there are twelve once-daily modified-release Isosorbide is used to manage anginal pain due to coronary artery disease, and it has approval for use in heart failure. Although a . Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. PDF dilatrate (isosorbide dinitrate) 40 mg DESCRIPTION - Food and Drug Some people may be able to stop taking it after certain types of heart surgery. The three forms of organic nitrates are described separately . Angina and heart failure is a warning sign that you are at risk of serious problems such as heart attacks and strokes. The route of administration for this medicine is oral, but it can be taken under the tongue as well. Thadani U, Rodgers T. Side effects of using nitrates to treat angina. Why Use Isosorbide Dinitrate vs Isosorbide Mononitrate? - Medscape Cardiology 24 years experience. Prevention or treatment of angina pectoris resulting from coronary artery disease - however, it is not recommended for use once the anginal episode has started because the onset of action is not sufficiently rapid enough to abort an acute anginal event. Roman S, Kahrilas PJ. % May decrease dosage to as little as of the fixed-combination tablet 3 times daily in patients who experience intolerable effects, but attempt to titrate dosage up once adverse effects subside. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 3.1 h) than when misoprostol-oxytocin (11.9 3.1 h) was used. stream Pharmacokinetics and pharmacodynamics of isosorbide dinitrate. 2 x 60mg tablets taken in the morning). Isosorbide is relatively safe within the therapeutic range. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. Sisenwine SF, Ruelius HW. (isosorbide dinitrate) Sustained Release Capsules 40 mg . Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. Summary for Vasodilator. !W#Lgy Product and Consumer Medicine Information. Isosorbide mononitrate differs from isosorbide dinitrate according to the number of nitro groups per molecule. Relieves chest pain. One manufacturer of isosorbide mononitrate states that dosage should be selected with caution, usually initiating therapy at the low end of the range, although age, renal, hepatic, and cardiovascular dysfunction do not appear to have a significant effect on drug clearance. ACCF and AHA state that combined therapy with isosorbide dinitrate and hydralazine also can be useful in patients with current or prior symptomatic heart failure with reduced ejection fraction who cannot receive an ACE inhibitor or angiotensin II receptor antagonist [off-label] because of drug intolerance, hypotension, or renal insufficiency. Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration. Isosorbide mononitrate vs dinitrate dose conversion Isosorbide mononitrate is usedto treat chest pain (angina) in adults and children above six years of age. Dr. Rick Koch answered. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. All rights reserved. 3 0 obj [Principles and rules of the use of nitrates] - PubMed Khaybullina D, Patel A, Zerilli T. Riociguat (adempas): a novel agent for the treatment of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. %H$Z7. Do not take non-steroidal anti-inflammatory medicines (NSAIDs) regularly, such as ibuprofen, aspirin and naproxen (unless it's prescribed by your doctor). If you have angina, to help avoid more attacks you may need to take at least 1 medicine every day for the rest of your life. ISDN is available in immediate release (Ex: Isordil) and extended release (Ex: DilatrateSR ) forms. Standard-release nitrate preparations: use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimize development of nitrate tolerance. Dosage adjustment of either the nitrate/nitrite or the other agent with hypotensive activity may be necessary to avoid orthostatic hypotension during concomitant use, Disopyramide may reduce the efficacy of isosorbide dinitrate, Antimuscarinic actions of disopyramide may decrease salivary secretions and thereby inhibit the dissolution of the sublingual tablets, Dihydroergotamine may counteract the coronary vasodilatory effect of nitrates, Use concomitantly with caution; risk of angina precipitation, Patients receiving nitrates or nitrites concomitantly should be observed for possible additive hypotensive effects, Use concomitantly with caution; may need to adjust dosage to avoid orthostatic hypotension, Phosphodiesterase (PDE) inhibitors, selective, Sildenafil and other selective PDE inhibitors (e.g., tadalafil, vardenafil) profoundly potentiate the vasodilatory effects (e.g., a >25-mm Hg decrease in SBP) of organic nitrates and nitrites (e.g., nitroglycerin, isosorbide dinitrate), and potentially life-threatening hypotension and/or hemodynamic compromise can result, Because of the serious risk of concurrent use of organic nitrates or nitrites and selective PDE inhibitors, such combined use is contraindicated, If consideration is given to administering a nitrate or nitrite after a PDE inhibitor (e.g., >24 hours after sildenafil use), the response to the initial doses must be monitored carefully and proper facilities for fluid and vasopressor (e.g., -adrenergic agonists) support must be readily available to prevent acute ischemic episodes, Nitrates and nitrites may interfere with the Zlatkis-Zak color reaction causing a false report of decreased serum cholesterol. Available for Android and iOS devices. No specific dosage recommendations for renal impairment. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. Chronic isosorbide use without drug-free intervals may cause poor symptom control and endothelial dysfunction due to the release of excessive free radicals.[26]. Organic Nitrates - LiverTox - NCBI Bookshelf Clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), should take a careful history so that concomitant use of organic nitrates or nitrites with selective PDE inhibitors can be avoided. This medication belongs to a class of drugs known as nitrates . [12], The two forms of isosorbide (isosorbide mononitrate and isosorbide dinitrate) vary extensively in their pharmacokinetic properties. They differ from each other according to their applications and properties. This helps your heart to work properly and reduces chest pain. In patients with hypertrophic cardiomyopathy, isosorbide decreases the preload and, hence, the left ventricular volume, worseningleft ventricular outflow tract obstruction.[11]. [22], Isosorbide releases NO, which stimulates the soluble guanylate cyclase. Required fields are marked *. Orang awam lebih mengenalnya dengan penyakit angin . When isosorbide dinitrate is used in fixed combination with hydralazine, consider the cautions, precautions, and contraindications associated with hydralazine. Headache, the most frequent adverse effect, may be severe (persistent or transient) and is perceived as a pulsating, throbbing sensation; frequent early in therapy, usually diminishes rapidly, and may disappear within several days to weeks of continuous therapy. Caution in volume depletion or preexisting hypotension. Isosorbide mononitrate and isosorbide dinitrate - NHS ;6YXZp2k>!'Z)IfFW`VG@Y!b /r980t ~pE Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate Adult 30-120 mg daily in divided doses. Angina adalah rasa nyeri atau tidak nyaman di dada karena kurangnya aliran darah ke jantung. [26]Tolerance may develop within as little as 12 to 24 hours,with a subsequent reduction in the clinical effects of isosorbide; this necessitates the need for a drug-free interval of at least 10 to 12 hours a day. Patients who fail to respond to nitroglycerin lingual or sublingual: 2.55 mg of isosorbide dinitrate. PDF (isosorbide mononitrate, USP) Rx Only - Food and Drug Administration It's important to stay active if you have angina or heart failure. It is an anti-anginal agent that works by relaxing the smooth muscles of both arteries and veins, but but predominantly veins to reduce cardiac preload. In angina, isosorbide mononitrate and dinitrate works by widening blood vessels (veins and arteries). Isosorbide dinitrate ISDN, often taken two or three times per day, begins acting within 15 to 30 minutes and lasts for three to six hours. Isosorbide dinitrate is a medication important in treating heart failure, oesophagal spasms, and treating chest pain that comes from not enough blood flow to the heart. Is there any food or drink I need to avoid? If you take isosorbide mononitrate or dinitrate 2 or 3 times a day, your doctor or pharmacist will explain how to space out your doses. It is not suitable to take to treat an angina attack - you should always carry with you a short-acting nitrate, such as glyceryl trinitrate (GTN), for if you get angina pain. Figure 01: The Chemical Structure of Isosorbide Mononitrate. [11]It directly increases the myocardial blood flow by dilating the large and medium-sized coronary arteries at higher doses. The major drawback of their therapeutic use is the rapid development of tolerance. VA class: CV250 Review the appropriate monitoring necessary with isosorbide. Other adverse effects can be due to the reflex activity of the sympathetic nervous system due to vasodilation. Describe the potential adverse effects patients may experience when using isosorbide. Your doctor may advise you to stop taking isosorbide mononitrate or dinitrate before surgery. But Its maximal effect is seen in venous capacitance vessels. After introducing isosorbide, its popularity temporarily decreased as Needleman and his colleagues questioned its efficacy as it underwent extensive biotransformation in the liver. Extended-release oral nitrate preparations should not be used in patients with functional or organic GI hypermotility or malabsorption syndrome. Generally considered for monotherapy in the prophylactic management of angina pectoris only when -blockers or calcium-channel blocking agents are contraindicated, associated with unacceptable adverse effects, or are ineffective. The Role of Nitroglycerin and Other Nitrogen Oxides in Cardiovascular Therapeutics. Isosorbide mononitrate and dinitrate usually starts to work within 1 hour. What is the Difference Between Isosorbide Mononitrate and Isosorbide Imdur vs. Ranexa Prescription Treatment for Chest Pain - RxList Administring normal saline. Weused pulse pressure as the in vivo haemodynamicindex, andshowedthat the ED50s (doses to reduce pulse pressure by 50%) were 10.2, 18.1, 43.2 and48.6mgkg-1, forL-isoidide mono-nitrate, isosorbide-2-mononitrate, isomannide mono-nitrate and5-ISMN,respectively (only a 5 . Like all medicines, isosorbide mononitrate and dinitrate can cause side effects, although not everybody gets them. Management of spastic disorders of the esophagus. Carefully individualize nitrate dosage to minimize the risk of tolerance; also consider potential risks of nitrate withdrawal. These may make your angina or heart failure worse. [14] In contrast, isosorbide mononitrate, an active metabolite of isosorbide dinitrate,does not undergo the first-pass effect, and its bioavailability is 100 percent after oral administration.[15][16]. Nitroglycerin is the fastest-working medicine to relieve chest pain, but make sure to sit down before taking it. mononitrate, isomannide mononitrate, isosorbide-2-mononitrate, and 5-ISMN. Conversion table Nitrates as an integral part of optimal medical therapy and cardiac rehabilitation for stable angina: review of current concepts and therapeutics. [Updated 2022 Jul 3]. isosorbide mononitrate (Imdur, Ismo, Monoket) - MedicineNet The medicine lowers blood pressure by causing veins to narrow and makes the heart more sensitive to the blood pressure (usually a very high blood pressure). Isosorbide mononitrate has one nirate group and isosorbide dinatrate has 2 nitro groups. Isosorbide Mononitrate: Fungsi Obat, Dosis, dll. Hello Sehat Due to the high prevalence of cardiovascular disease among the general population, effective management of anginal pain and heart failure with significant interprofessional communication plays a crucial role in reducing mortality and readmission rates with long-term benefits of improved exercise tolerance and quality of life. Will I need to stop taking it before surgery or before tests? Congestive heart failure: Oral: Initial: 10 mg 3 times/day. Isosorbide Mononitrate in Heart Failure with Preserved Ejection The manufacturer of the fixed combination of isosorbide dinitrate and hydralazine hydrochloride states that dosage should be selected with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. Summarize the importance of collaboration and communication amongst the interprofessional team to enhance care delivery and improve outcomes for patients with angina pectoris receiving isosorbide. Apart from limiting alcohol, you can eat and drink normally while you are taking isosorbide mononitrate or dinitrate. If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, talk to your health visitor, midwife or doctor.