Imidu 60mg Hasan medicine for preventive treatment (3 blisters x 10 tablets)

Dosage form Box of 3 blisters x 10 tablets
Specifications Isosorbid-5-Mononitrat

Ingredient

Composition information	Content
Isosorbid-5-Mononitrat	60mg

Uses

indicated

imidu 60 is indicated for preventing angina.

Pharmacology

Pharmacological classification: Preventive medicine for angina.

ATC code: C01DA14.

Mechanism of action

Isosorbid-5-Mononitrate (Isosorbid Mononitrate) belongs to a group of vasodilators, which is the active metabolitus of isosorbid dinitrate. When entering the body, nitrates are converted into oxyde nitric (NO) radicals by glutathion-S-Reductase and cysteine. NO combined with the thiol group into nitrosothiol (R-Sno), this substance activates Ganylat Cyclase to convert guanosin triphosphate (GTP) into Guanosin 3.5'-Monophosphate (GMPC).

GMPC makes myosin in the muscle fibers of vascular walls not activated, unable to combine with Actin so it should dilate.

The nitrates actually act on the vein system, with high doses that relax both artery and coronary arteries, thereby reducing money and posterior burden. The result reduces blood pressure, especially systolic blood pressure, although not much but can cause sympathetic reflexes that make the vessels slightly and increase the heart contraction.

Nitrate also has the effect of inhibiting platelets. In the failure, reducing the burden, reducing the burden will reduce the attack and consumption of oxygen of the heart muscle, supply and demand for oxygen of the balanced heart muscle will quickly cut angina.

The drug also relaxes coronary artery, losing vascular spasms. Long -term use also has the effect of re -distributing blood benefits for the inner parts and developing the circulatory system.

In heart failure, due to reducing the amount of blood in the heart, it improves the burden of money, reduces the right ventricular pressure and pulmonary circulation pressure. Thus reduces the signs of blood stasis, with the appropriate dose, the drug reduces the burden, creates better conditions for the heart to gain blood, increases the volume of systolic and cardiac supply.

Using long -term nitrates is prone to the phenomenon of "reducing or loss of drug tolerance", which loses the effects of the drug.

It is explained that may be due to a lack of reserves -Sh, due to the lack of glutathion-S-Reductase enzymes needed to metabolize nitrates, due to increased intravascular volume, active mechanisms that make vascular vasoconstriction that responds to vasodilation effects of the drug. So during the day, there should be a period of at least 8 hours without drugs.

Pharmacokinetics

absorption

Isosorbid-5-Mononitrate is easy to absorb through the gastrointestinal tract. Birth is about 77 - 80%. The peak concentration of plasma is about 3 - 4.5 hours after drinking. Food reduces the absorption rate but does not affect the level of absorption of the drug.

Distribution

Isosorbid-5-Mononitrate is less attached to plasma proteins (

Metabolism

Isosorbid-5-Mononitrate metabolizes the main liver into non-active substances, including isosorbid and isosorbid glucuronic. Isosorbid-5-Mononitrate does not first metabolized through the liver, so the plasma concentration is not different between different patients. Therefore, clinical effects can be repeated and predicted.

At the blood vessel muscle cells isosorbid-5-mononitrate transformed into organic trinite forms, finally into oxydnitric.

Elimination

Isosorbid-5-Mononitrate is eliminated mainly in urine in the form of metabolites (about 2% in the form of intact). Selling time is about 4-5 hours, total clearance is about 115 ml/min.

linear

There has been a report to prove the long-lasting effect ISOSORBID-5-Mononitrate Linear pharmacokinese up to the level of 120 mg.

Pharmacokinetics on some special clinical subjects

Patients liver failure , renal failure: do not change much about pharmacokinetic parameters compared to patients with normal liver and kidney function.

Before taking Imidu 60mg Hasan medicine for preventive treatment (3 blisters x 10 tablets)

How to use

single dose in the morning. Do not chew or crush the pill. Swallow whole or half pill (after breaking) with water.

Patients need to take the drug in accordance with the doctor's instructions, not to stop the drug. Constantly the drug suddenly, should gradually reduce the dose and frequency of drug use before stopping the drug.

Dosage

Adults

The starting dose is 1 tablet (60 mg/day, can increase to 2 tablets (120 mg)/day after a few days if necessary. The starting dose may be reduced to 30 mg/day to limit the unwanted headache for the first 2-4 days.

Dosage in some special clinical subjects:

Children

Safety and efficiency have not been established in children.

Elderly

There is no evidence of adjusting the dose in the elderly. However, special monitoring should be monitored in subjects to increase sensitivity to hypotension, liver failure or kidney failure.

Note:

Should use the drug at the lowest dose effectively. In patients with the phenomenon of tolerance of drugs, it is advisable to use antidote in batches. If the time of remembering is close to the next dose time, skip the forgotten dose and continue taking the next dose as usual.

Do not take double dose to compensate for the forgotten dose.

What to do when overdose?

Symptoms

The most common symptom when overdose is hypotension, headache such as a hammer, tachycardia, blushing. When the dose is too high, methemoglobin can occur.

How to handle

Treatment of hypotension: It is necessary to let patients in a lying position raise two legs, can be injected with fluid, treat purple blue due to methemoglobin blood by methylene methylene effect 1 - 2 mg/kg. Gastric lavage immediately if used by oral.

There is no special requirement on drug treatment after use. Do not throw away drugs in wastewater or domestic waste. Consult the pharmacist how to quit unused. These measures will help protect the environment.

Side Effects

When using Imidu 60 , you may experience unwanted effects (ADR).

Headache usually occurs when starting to take the drug and usually recover after 1-2 weeks of treatment. The starting dose may be reduced to 30 mg/day to limit the unexpected headache for the first 2-4 days. Hemorrhage drops (dizziness, nausea) are occasionally reported. These symptoms are often cured when continuing treatment.

Unwanted effects are divided by frequency: Very common (ADR> 1/10), common (1/100 Neurological: headache , dizziness (common). Stunning (rare). cardiovascular: hypotension, fast heart (common).

digestive: Nausea (common). Vomiting, diarrhea (rarely).

Skin and subcutaneous tissue: Red, itchy (rare).

Muscle and connective tissue: Muscle pain (very rare).

Warnings

Contraindicated

imidu 60 Contraindications for the following cases:

Hypersensitivity to isosorbid-5-Mononitrate, nitrates or any ingredients of the drug. brain ...).

Be cautious when using

Do not use imidu 60 mg in the treatment of acute angina. When acute angina occurs, Glycerin trinitrate should be used under the tongue.

Use cautiously in patients with a history of myocardial infarction or patients with hypothyroidism, heat lowering, malnutrition, severe liver disease, severe kidney disease. Should use the lowest dose effectively.

The tolerance has occurred in some patients taking the drug for a long time. In these patients, antidote should be released in batches. Do not stop the drug suddenly but gradually decrease the dose and frequency.

Hypotension effects due to nitrate may be accompanied by a paradoxical slow heart rate and increased the risk of chest pain. Hypoglycemia, especially in a vertical position, can occur even in low doses. Precautions in patients with decreased volume or lower blood pressure.

When using the drug, the dose must be increased slowly to avoid the risk of hypotension and headache in some patients, should sit or lie after using the drug.

Serious hypotension is accompanied by mild and dizzy headache often observed when used with alcohol -containing preparations.

5-shark inhibitors: increases the potential of hypotension of nitrates and organic nitrite, which can be life-threatening or adversely affecting dynamics. Doctors need to know the patient's medication fee, especially in myocardial infarction or ischemia. Warning patients with interactions that may occur to eliminate the ability to use simultaneously.

Benefits in patients with congestive heart failure and myocardial infarction have not been established, clinical monitoring and hemodynamics need to be strict when using the drug. Avoid the use of long -lasting preparations during the initial treatment in the above patients because the effect of the drug is difficult to stop quickly, may occur excessive blood pressure and fast heart rate.

IMIDU 60 mg contains lactose. Patients should not be used in patients with rare genetic disorders in galactose intolerance, Lapp Lactase enzyme deficiency or glucose-Galactose absorption disorders.

pregnancy or lactation

Pregnant women

There is no clinical research data on the use of isosorbid-5-Mononitrate in pregnant women. Animal research shows that reproductive toxicity and correlation in humans are not known. Therefore, ISOSorbid-5-Mononitrate should not be used for pregnant women unless necessary.

breastfeeding women

Isosorbid-5-Mononitrate should not be used for nursing women, unless the benefits are greater than possible.

The ability to drive and operate machinery

isosorbid-5-mononitrate has an average impact on the ability to drive, operate machinery because it can cause dizziness. Patients should only drive or operate machinery when ensuring that they are not affected by the above -mentioned effect.

Drug interaction

noradrenalin, acetylcholin, histamine

Isosorbid-5-Mononitrate can oppose pharmacological effects with these drugs.

alcohol

can cause ischemic anemia accompanied by posture hypotension.

Beta receptor blockers

Has other pharmacological effects in angina and plus effects when used simultaneously with isosorbid-5-mononitrate.

Enzyme inhibitors, 5- Phosphodiesterase inhibitors ( Sildenafil , Tadalafil and Vardenafil)

Increases the hypotension effect of nitrate when used in combination, which can cause serious blood pressure vasodilation, there have been cases of death.

Tyeum of drugs

Not applicable.

Storage

Store in a dry place, below 30 ° C. Avoid light.

Expiry date: 60 months (from the date of manufacture).

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