PROPHYLAXIS OF ANGINA AND PREVENTION OF SECONDARY MI
Adult:
Starting dose of ISMN and aspirin (60mg/75mg) is one or two tablets in the morning and of ISMN and aspirin (60mg/150mg) is one in the morning.
Precautions
Infants with hyperbilirubinuria because of risk of kernicterus resulting from displacement of bilirubin from plasma albumin. Neonates, children, nursing mothers, elderly, volume depletion, hypotension. Hypotension induced by ISMN may be accompanied by paradoxical bradycardia and increased angina pectoris. Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy.
Aspirin: Caution to be exercised while using aspirin with anticoagulants. Large doses of salicylates including aspirin may exert hypoglycaemic action and may enhance the effect of the oral hypoglycaemics. If necessary, the dosage of the hypoglycaemic agent must be reduced while the salicylate is given. This hypoglycaemic action may also affect the insulin requirements of diabetics. Aspirin may decrease the effects of probenecid, sulfinpyrazone and phenylbutazone. Sodium excretion produced by spironolactone may be decreased in the presence of salicylates. Alcohol and aspirin exhibit synergistic effect in causing GI bleeding. Risk of GI ulceration may be seen following concomitant admin of pyrazolone derivatives (phenylbutazone, oxyphenylbutazone and possibly, dipyrone) with aspirin. Urinary alkalisers may decrease aspirin effectiveness. Phenobarbital is likely to decrease aspirin effectiveness by enzyme induction. Aspirin is likely to increase the serum phenytoin levels. Aspirin's anti-inflammatory action may be decreased by propanolol probably by competing for the same receptors. Isosorbide mononitrate: Orthostatic hypotension may occur with combined use of calcium channel blockers, antihypertensive agents, phenothiazines and TCAs. Use of ISMN with alcohol may produce severe hypotension and collapse.
