the package insert of the medicine Coronar. Active principles Isosorbide Mononitrate.
Coronar ® is indicated in the prevention and treatment of angina pectoris (angina of effort, resting and post-myocardial) and, also, as an adjunct to insufficiencies in cardiac acute and chronic, in association with glicosídios cardioativos, diuretics and inhibitors of angiotensin-converting enzyme.
When should I not use?
Patients with hypersensitivity to the components of the formulas. In cases of severe arterial hypotension. Coronar ®, why not take action fast enough, is not indicated for the treatment of acute attacks of angina.
How to use?
Tablets: the usual dosage recommended of Coronar ® is 20 mg, twice a day, with an interval of 7 hours between them. The majority of the patients require doses of between 40 and 60 mg/day. The doses may reach up to 120 mg/day, divided into 2 or 3 sockets. It is recommended to start treatment with small doses of Coronar ® and increase them gradually according to response to therapy and tolerance of the patient.
Patients who have never received treatment with nitrates or patients of low body weight can start with 10 mg (1/2 tablet of 20 mg) of Coronar ® and, after a few days (2 to 3) of therapy, move on to 20 mg of Coronar ®, two times a day.
elderly Patients, patients with altered hepatic or renal: do not require adjustment of dosages.
. intravenous: 20 to 80 mg (average of 0.8 mg/kg of body weight) of Coronar ® injectable every 8 or 12 hours.
. intracoronário: 10 to 20 mg
Continuous infusion intravenous 0.8 mg of Coronar ® injectable/kg body weight, diluted in 100 ml saline or sugar (to apply for 2 to 3 hours, with an interval of 8 or 12 hours between them), or at the physician’s discretion.
What are the evils that can cause me?
headache is the most frequent side-effect pointed out. The headache decreases incidence after a few days of therapy. It can also be relieved with the use of analgesics or temporary reduction of the dosage. Other effects such as fatigue, dizziness, nausea, abdominal pain, skin rashes, allergic reactions, chest pain, diarrhea, sweating, and collapse may occur.
Warnings and Precautions
what should I know before using?
General – May occur hypotension severe, particularly in the standing position, even with small doses of isosorbide mononitrate. Should be used with caution in patients that have the blood volume depletado or that for any reason are already hipotensos. Hypotension caused by isosorbide mononitrate may be accompanied by paradoxical bradycardia and increased angina pectoris.
Therapy with nitrates may aggravate angina caused by hypertrophic cardiomyopathy.
Workers in industries that were exposed to doses unknown (presumably high) nitrates organic, showed tolerance to the drug. Pain toráxicas, acute myocardial infarction, and even sudden death have occurred with the temporary withdrawal of nitrates from these workers, demonstrating the existence of true physical dependence. Thus, it is recommended that discontinuation of therapy with Coronar ® is made slowly and gradually.
Pregnancy – Coronar ® should not be administered to pregnant women unless the expected benefits to the patient outweigh the risks to the fetus, according to the physician’s discretion.
Lactation – it is Not known whether isosorbide dinitrate is excreted in human milk.
The decision whether to suspend breast-feeding or treatment with Coronar ® should be made taking into consideration the importance of the drug to the mother and the risk to the child.
Pediatrics – have Not been established the safety and efficacy of isosorbide mononitrate for children.
Geriatric care (elderly) – elderly Patients may be more sensitive to the effects hipotensores of nitrates. Also attention should be paid to the decrease of renal function caused by age.
what to do if someone use a larger amount than is recommended?
The effects of an excessive dosage of nitrates are: vasodilation, venous pooling, bradycardia, and hypotension. these changes in hemodynamic can lead to manifestations of protein, including increased intracranial pressure with headache throbbing persistent, mental confusion, fever, vertigo, palpitations visual disturbances, nausea and vomiting (possibly with colic and even bloody diarrhea), syncope (especially in upright position), where with cyanosis and anoxia, hiperpnéia initial, dyspnea, bradipnéia, sweating (with the skin making it cool and cianótica), paralysis, coma that can lead to death.
The recommended treatment for the overdose starts with gastric lavage (if ingestion recent and the patient is conscious); keep the patient lying down on the shock position and comfortably warm; movements in the liabilities of the ends is used to assist the venous return, administering oxygen, and proceed with artificial respiration; in case where, administer 1 to 2 mg/kg of body weight of methylene blue 1% intravenously.
Is contra-indicated the use of epinephrine and its related cases of hypotension severe because of the overdose by isosorbide mononitrate. do not know if the drug is dialyzable.
the pharmaceutical Forms and presentations:
Pill 20 mg. box with 30 tablets.
Pill 40 mg. box with 30 tablets.
injectable Solution 10 mg/ml. box with 50 ampoules of 1 ml.
. Other vasodilation: the vasodilation effects of isosorbide mononitrate can be increased with the concomitant use of other drugs vasodilators. Alcoholic beverages, in particular, to promote such additive effects.
. Anti-hypertensive drugs, beta-adrenergic blockers or fenotiazínicos: in joint use with Coronar ®, can accumulate the effects hipotensores.
. Calcium channel blockers and nitrates: marked orthostatic hypotension symptomatic has been reported with concomitant use with Coronar ®.
Interference In Laboratory Tests
excessive Doses of nitrates can increase the concentration of which in the blood.
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