Drug Class: Organic Nitrate / Vasodilator | Form: Extended-Release Oral Tablet | Prescription Status: Prescription Only (Rx) — DRAP Registered
What is Monis XR 60mg Tablet? Monis XR 60mg contains Isosorbide Mononitrate in an extended-release formulation — providing sustained vasodilation throughout the day from a single once-daily dose. The XR formulation releases the medicine gradually, maintaining consistent blood vessel relaxation and preventing the rapid peak-and-trough effect of immediate-release nitrates that causes headaches and tolerance. It is prescribed exclusively for prevention and long-term management of chronic stable angina — it has no role in treating acute chest pain attacks where fast-acting sublingual nitrates are required instead. Must be swallowed whole and never crushed or chewed.
What is Monis XR 60mg Used For?
- Chronic stable angina prevention — recurring chest pain from reduced heart blood flow (سینے کے درد کی روک تھام)
- Long-term angina management in coronary artery disease (دل کی شریانوں کی بیماری میں سینے کا درد)
- Reducing frequency and severity of angina episodes (انجائنا کے دوروں کی تعداد کم کرنا)
- Reducing cardiac workload in patients with established ischaemic heart disease
- Adjunctive therapy alongside beta-blockers or calcium channel blockers for angina control
How Does it Work? Isosorbide Mononitrate releases nitric oxide in vascular smooth muscle cells — activating guanylate cyclase enzyme which increases cyclic GMP levels, causing smooth muscle relaxation and vasodilation. This produces two complementary beneficial effects. First, venous dilation reduces the amount of blood returning to the heart — decreasing cardiac preload and the heart's workload. Second, coronary artery dilation improves blood flow and oxygen delivery directly to the heart muscle. Together these effects prevent the supply-demand mismatch that causes angina pain. The extended-release formulation maintains these effects steadily throughout the day while the nitrate-free interval overnight prevents tolerance development.
Dosage and Administration
⚠️ Swallow whole — never crush, chew, or break the extended-release tablet. Take in the morning. A nitrate-free interval of 10 to 12 hours overnight is essential to prevent tolerance. Never stop suddenly in long-term users. This tablet does NOT treat acute angina attacks — always carry a fast-acting sublingual nitrate for acute episodes.
| Indication | Usual Adult Dose | Frequency | Notes |
|---|---|---|---|
| Chronic stable angina prevention | 30 – 60mg | Once daily in morning | Swallow whole — do not crush |
| Established ischaemic heart disease | 60mg | Once daily in morning | Adjusted by cardiologist |
Active Ingredients
| Ingredient | Strength |
|---|---|
| Isosorbide Mononitrate | 60mg (Extended-Release) |
Who Should NOT Take Monis XR 60mg?
- Allergy to Isosorbide Mononitrate, any organic nitrate, or nitrite compound
- Currently taking PDE-5 inhibitors — Sildenafil (Viagra), Tadalafil, or Vardenafil — life-threatening blood pressure drop
- Severe hypotension — systolic blood pressure below 90mmHg
- Hypovolaemia — significant dehydration or blood loss
- Severe anaemia — nitrates worsen oxygen delivery in severe anaemia
- Acute myocardial infarction with low filling pressures — specialist assessment required
- Hypertrophic obstructive cardiomyopathy
- Constrictive pericarditis or cardiac tamponade
- Closed-angle glaucoma
- Severe liver impairment
Side Effects
Common: Throbbing headache — most common especially when starting treatment (سر درد — عام طور پر وقت کے ساتھ کم ہوتا ہے), facial flushing and warmth (گرمی کا احساس), dizziness especially on standing up quickly, mild nausea, mild weakness — most side effects reduce significantly after the first few days of treatment.
Serious — Stop and seek emergency help immediately: Severe sudden drop in blood pressure with fainting — particularly if PDE-5 inhibitor taken (بلڈ پریشر کا اچانک گرنا — فوری ہسپتال جائیں), severe persistent headache not responding to Paracetamol, methaemoglobinaemia — bluish discolouration of lips and fingertips with breathing difficulty (ہونٹوں کا نیلا ہونا — فوری مدد لیں), worsening angina or chest pain — may indicate tolerance development, severe allergic reaction with skin rash and facial swelling.
Drug Interactions
| Medicine | Interaction |
|---|---|
| PDE-5 inhibitors (Sildenafil, Tadalafil, Vardenafil) | Life-threatening severe hypotension — absolutely contraindicated; never combine |
| Antihypertensives / beta-blockers / calcium channel blockers | Additive blood pressure lowering — increased hypotension and dizziness risk |
| Other nitrates (sublingual GTN) | Additive vasodilation — monitor blood pressure carefully |
| Alcohol (شراب) | Severely increases vasodilation and hypotension — avoid completely |
| Heparin | Isosorbide Mononitrate may reduce Heparin anticoagulant effect — monitor closely |
| Dihydroergotamine | Nitrates increase Ergotamine absorption — increased vasospasm risk |
| Antidepressants (TCAs) | Additive hypotensive effect — increased dizziness and fainting risk |
Storage: Store below 25°C in a cool, dry place. Protect from moisture and direct sunlight. Keep in original packaging. Keep out of reach of children (بچوں کی پہنچ سے دور رکھیں). Do not use after expiry date.
FAQs
Q: Can I use Monis XR 60mg to treat sudden acute chest pain attacks? No — Monis XR is a preventive medicine only. It works too slowly to treat acute angina attacks. Always carry a fast-acting sublingual nitrate spray or tablet prescribed by your cardiologist for immediate relief of acute chest pain episodes.
Q: Why must Monis XR be taken in the morning with a nitrate-free period overnight? Taking the tablet in the morning ensures vasodilation during the most active daytime hours while allowing a natural nitrate-free interval overnight — this prevents nitrate tolerance where the medicine loses effectiveness with continuous round-the-clock exposure.
Q: Why can I absolutely not take Viagra or similar medicines with Monis XR? Both nitrates and PDE-5 inhibitors lower blood pressure through different but complementary pathways — combining them causes a sudden catastrophic drop in blood pressure that can cause fainting, heart attack, or death. This combination is absolutely contraindicated under all circumstances.
Medical Disclaimer: This information is for general awareness only and does not replace medical advice. Always consult a qualified doctor or pharmacist before taking any prescription medicine.