Monosan tab 20mg 30 pc

Description

Composition
Active substance:
Isosorbide mononitrate 20/40 mg [in solution with lactose hydrate 80% / 20% – 25/50 mg].
Product form:
20 tablets, 40 mg (blisters).
Contraindications
Hypersensitivity.
Dosage
20 mg
Indications
Angina (prevention). Heart failure, hypertension in the “small” circle of blood, “pulmonary” heart (treatment as part of combination therapy). Spasm of peripheral arteries (arterial occlusive disease, retinitis angiospastic).
Interaction with other drugs
Increasing the concentration of dihydroergotamine in plasma. It reduces the effect of vasopressors. Barbiturates accelerate metabolism and reduce the concentration of isosorbide mononitrate in the blood. In a joint application isosorbide mononitrate with antihypertensive drugs, vasodilators, antipsychotic drugs (neuroleptics) tricyclic antidepressants procainamide, ethanol, quinidine, beta-blockers, BCCI, and sildenafil dihydroergotamine may increase the hypotensive effect. In combination with amiodarone, propranolol, BCCI (verapamil, nifedipine, etc.) May increase antianginal effect. Under the influence of beta-agonists, alpha-blockers (dihydroergotamine et al.) May decrease the severity antianginal effects (tachycardia and excessive lowering of blood pressure). The combined use of a m-holinoblokatorami (atropine, etc.) Increases the probability of increased intraocular pressure. Adsorbents, binders and overlying drugs reduce the absorption of isosorbide mononitrate in the digestive tract.
Overdose
Collapse, syncope, headache, dizziness, palpitations, visual disorders, hyperthermia, convulsions, skin flushing, sweating, nausea, vomiting, diarrhea, methemoglobinemia (cyanosis, anoxia – usually chronic overdose), hyperpnea, dyspnea, bradycardia, increased intracranial pressure, paralysis, coma. Treatment gastric lavage at methemoglobinemia – inside or / ascorbic acid 1 g / in 1% solution methylthioninium chloride 1-2 mg / kg (50 ml), oxygen therapy, hemodialysis, exchange transfusion. Symptomatic therapy in marked decrease in blood pressure – in / phenylephrine (epinephrine, and related compounds are ineffective).
pharmachologic effect
Pharmacological group:
Vasodilating agent – nitrate.
Pharmacological properties:
Antianginal, venodilatiruyuschee nitrate, skin ,.
Pharmacodynamics:
Peripheral vasodilator with a predominant influence on the venous vessels. It stimulates the formation of nitric oxide (endothelium-derived relaxing factor) in the vascular endothelium, causing intracellular activation of guanylate cyclase, resulting in an increase in the cGMP (vasodilation mediator). Reduces myocardial oxygen demand by reducing preload and afterload (reducing EDV and LV systolic stress reduces its walls). It has koronarorasshiryayuschee action. Reduces blood flow to the right atrium, it helps reduce the pressure in the “small” circulation and regression of symptoms in pulmonary edema. Promotes redistribution of coronary blood flow in the area of ​​reduced blood circulation. Increases exercise tolerance in patients with coronary heart disease, angina. It extends the cerebral vessels of the dura mater, which can be accompanied by headache. As well as to others. Nitrates, develop cross-tolerance. After a break in the use of sensitive to it recovers quickly. Antiangialny effect occurs within 30-45 minutes after oral administration and lasts for 8-10 hours.
Pharmacokinetics:
Absorption – high, bioavailability – 100%. achieve therapeutic concentration (100 ng / ml) – 30 min. TCmax – 1-1.5 h, to retard forms – 8 hours Connection to plasma proteins -. Less than 4%. Undergoes denitration isosorbide to form glucuronide or connected to. T1 / 2 -. 5 hours excreted by the kidneys as glucuronide.
side effects
From the CCC headache, dizziness, facial flushing, heat sensation, tachycardia, decreased blood pressure. In rare cases – increased angina (paradoxical reaction), and collapse. From the digestive system nausea and vomiting, may occur feeling of slight burning tongue, dry mouth. From the nervous system stiffness, drowsiness, blurred vision, decreased ability to rapid mental and motor reactions (especially at the beginning of treatment). In rare cases – cerebral ischemia. Allergic reactions are skin rash. Other development of tolerance (including a cross al. Nitrate), exfoliative dermatitis.
special instructions
During treatment requires monitoring of blood pressure and heart rate. If necessary use the drug on the background of arterial hypotension be simultaneously administered drugs possessing positive inotropic effect, or to apply an auxiliary circulation means. Frequent administration, and high doses may cause the development of tolerance, in this case it is recommended to cancel or 24-48 hours after 3-6 weeks of regular reception make a break for 3-5 days, this time replacing isosorbide mononitrate al. Antianginal drugs. abrupt discontinuation should be avoided (the dose reduced gradually). During the period of treatment must be careful when driving and other lesson. Potentially hazardous activities that require high concentration and psychomotor speed reactions.
Carefully. For all forms (comparing the risks and benefits) – hemorrhagic stroke, recently transferred brain injury, acute myocardial infarction (risk reduction in blood pressure and tachycardia which can enhance ischemia), glaucoma (risk of increased intraocular pressure), severe anemia, thyrotoxicosis, hypotension low systolic blood pressure (may aggravate the condition, causing a paradoxical bradycardia and angina), HCM (possibly increased frequency of angina attacks), severe renal failure, liver failure (risk of methemoglobinemia ), Pregnancy, lactation, infancy (safety have not been established). For prolonged dosage forms for oral administration – increased gastrointestinal motility, malabsorption syndrome.
Dosing and Administration
Orally (tablets, capsules) for 1 hour before or 2 hours after eating. Capsule to take, without chewing, with a glass of water. Starting dose – 10-20 mg 2 times a day (for PM average duration) or 40-50 mg 1 time per day (to retard and depot tablets capsules). Starting from 3-4 day dose can be increased up to 20-40 mg 2 times a day (for PM average duration of action), increasing the dosage if necessary to 60-80 mg / day. The maximum daily dose – 80 mg.
Information
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist