Notes for: NitratesLast edited [22/08/2013 15:39:12]
It is generally accepted that a nitrate-free period is advisable to minimise the risk of tolerance. This can be achieved by prescribing ordinary release isosorbide mononitrate twice a day, six to eight hours apart (eg in the morning and after lunch).
Modified-release preparations (which are several times more expensive) should be reserved for patients unable to comply with these timings, and should only ever be prescribed once a day. Monomil XL® is currently the preferred choice. However, when there are supply
issues with the ordinary release isosorbide mononitrate tablets the modified
release preparations can offer a cost effective alternative. Monomil XL 60mg
tablets can also be split to achieve a 30mg daily dose. Or if there is a
clinical need to prescribe either a 25mg or 50mg daily dose then Elantan LA
capsules could be considered.