Iso-mic

A drug for the treatment of cardiovascular diseases. Let's consider the indications for its use, side effects, dosage and other pharmacological features. International name Iso-mic: isosorbide dinitrate -1,4 3,6-dianhydrosorbitol-2,5 dinitrate. It belongs to the pharmacological group of drugs that improve blood supply and myocardial metabolism. An antianginal drug with the active ingredient is isosorbide dinitrate, belongs to the group of organic nitrates. Stimulates relaxation of the smooth muscle layer of blood vessels, which causes a decrease in peripheral resistance and blood flow to the right atrium. The antianginal effect is due to an increase in the lumen of the coronary vessels and a redistribution of coronary blood flow in favor of ischemic areas.

Indications Iso-mic

The drug is used as prescribed by a doctor and has the following indications for use:

• Unstable angina
• Acute myocardial infarction
• Acute left ventricular failure
• Vasospastic angina (Prinzmetal's)

Tablets and spray are used to prevent angina attacks in patients with cardiac ischemia. They are effective in chronic heart failure and severe pulmonary hypertension syndrome.

Parenteral forms of Iso-mic are prescribed for patients with acute conditions: acute myocardial infarction, acute left ventricular failure, pre-infarction condition, unstable angina.

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Release form

Iso-mic is available in several forms, let's look at each of them:

• Spray

Available in dark glass bottles of 15 ml each. The sublingual aerosol contains 375 mg of isosorbide dinitrate.

• Ampoules

Concentrate for the preparation of a solution for infusion. Available in 2 ml ampoules or 5 ml vials. One cardboard pack contains 10 ampoules or 5 vials. 1 ml of the medicine contains 10 mg of isosorbide dinitrate.

• Injection solution

Dark glass ampoules of 10 ml each, 10 ampoules in a package. 1 ampoule of solution contains 10 mg of isosorbide dinitrate.

• Sublingual tablets

Capsules in polymer bottles, 50 pieces each. Tablets are available in dosages of 5, 10 and 20 mg of isosorbide dinitrate. As auxiliary substances: sorbitol and sugar.

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Pharmacodynamics

Isosorbide dinitrate is the active ingredient of Iso-mic. The pharmacodynamics of the drug is associated with the release of active components of nitric oxide in the smooth muscles of the vascular system. Nitric oxide increases the level of cyclic 3.5 guanosine monophosphate and promotes the activation of guanylate cyclase. This promotes relaxation of smooth muscles. Under the influence of the active substance, precapillary sphincters and arterioles relax much less than veins and large arteries.

Isosorbide dinitrate is a peripheral dilator that acts on venous vessels. It reduces myocardial oxygen demand by dilating peripheral veins and reducing inflow to the right atrium before exercise, and reduces total peripheral vascular resistance after exercise.

The active substance redistributes coronary blood flow to areas with reduced blood supply. Increases tolerance to physical activity in ischemic heart disease and angina. Unloads the myocardium in heart failure due to pre-loads, and also reduces pressure in the pulmonary circulation.

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Pharmacokinetics

When using sublingual forms of Iso-mic (spray, tablets), the therapeutic effect occurs within 2-5 minutes and lasts up to 1-2 hours. Pharmacokinetics indicates that the maximum plasma concentration is reached within 5-6 minutes. With parenteral administration, the effect occurs within 1-2 minutes after infusion. Oral forms are characterized by a prolonged therapeutic effect of 4-5 hours. The maximum plasma concentration is reached within 2 hours, bioavailability is 22% (during the first pass through the liver).

Isosorbide dinitrate is metabolized in the body and forms two active metabolites. They are excreted within 5 and 2.5 hours. Isosorbide dinitrate is excreted within 1-5 hours regardless of the method of administration. With a long course of treatment, the half-life increases. Within 24 hours, 80-100% of the dose taken is excreted via the kidneys.

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Dosing and administration

Depending on the medical indications and the form of release, the patient is prescribed the method of administration and dosage of Iso-mic.

• Sublingual tablets are taken before expected emotional or physical stress. The pills are held under the tongue until completely dissolved or chewed. Recommended dosage: 1-2 pcs. 3-4 times a day, the duration of treatment is determined by the doctor.
• Tablets for oral administration are washed down with clean drinking water, without chewing. As a rule, 10-20 mg of the drug is prescribed 2-3 times a day, the maximum dosage is 120 mg of isosorbide dinitrate per day. A time interval of 4 hours must be observed between doses.
• The injection solution is dissolved in the infusion solution and administered intravenously by drip. For this, 400 ml of isotonic sodium chloride solution and 50-100 ml of Iso-mic injection solution are used. The dosage and duration of treatment are individual for each patient.
• The concentrate for the preparation of the infusion solution is used immediately after dilution and is administered intravenously by drip. The dose and duration of therapy depend on the patient's condition. Monitoring of blood pressure, heart rate, ECG and diuresis is required.
• Sublingual spray is sprayed under the tongue. When spraying, hold your breath and breathe through your nose. There should be a 30-second interval between sprays of the aerosol. For treatment, 1-2 sprays are prescribed 3-4 times a day.

During long-term therapy, it is necessary to take weekly breaks every 4-6 weeks of use, regardless of the form of the drug.

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Use Iso-mic during pregnancy

The drug Izo-Mik is not recommended for use during pregnancy and lactation. The prescription of the drug during this period may be associated with vital indications. But in this case, it is necessary to take into account the possibility of developing pathological reactions in the fetus.

The drug is not used in pediatric practice due to the lack of reliable data on the safety of its use.

Contraindications

Iso-mic has contraindications for use, which are based on the individual reaction of the body to the active substance. The drug is not prescribed in the following cases:

• Acute vascular insufficiency
• Severe arterial hypotension
• Cardiac tamponade
• Constrictive pericarditis
• Hypertrophic obstructive cardiomyopathy
• Cardiogenic shock
• Severe anemia
• Closed-angle glaucoma
• Toxic pulmonary edema and hyperthyroidism
• Recent traumatic brain injury
• Hemorrhagic stroke

Parenteral forms are not used in cases of severe anemia, severe renal and hepatic dysfunction. The drug is prescribed with special caution to patients with acute myocardial infarction with low blood pressure, cerebral circulatory disorders, increased intracranial pressure, aortic or mitral stenosis.

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Side effects Iso-mic

During the use of Iso-mic, some patients may develop side effects. Adverse reactions are caused by the active component - isosorbide dinitrate:

• Cardiovascular system: hyperemia of the face and upper body, attacks of angina pectoris, short-term hypoxemia, decreased blood pressure, reflex tachycardia, collapse.
• Gastrointestinal tract: dry mouth, nausea and vomiting, burning and tingling in the mouth, heartburn, relaxation of the sphincter.
• Central nervous system: weakness, sleep problems, decreased visual acuity, headaches and dizziness, cerebral ischemia.

In addition, skin allergic reactions (itching, burning, redness), tolerance to nitrates are possible. When using Iso-mic, it is not recommended to do work that requires increased attention and operate potentially unsafe mechanisms. This is due to the fact that the drug can cause dizziness, decreased visual acuity.

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Overdose

High doses of the drug may lead to overdose. Most often, these are signs of arterial hypotension and reflex tachycardia. Overdose may provoke methemoglobinemia, severe headaches, nausea, and rapid heartbeat.

• If blood pressure drops sharply, it is necessary to administer an isotonic sodium chloride solution. This will help restore the volume of circulating blood.
• In case of severe hypotension, Norepinephrine and Dopamine are used.
• For methemoglobinemia, 1 g of ascorbic acid is taken orally, oxygen therapy and intravenous administration of 50 ml of 1% methylene blue solution.

Since there is no specific antidote, symptomatic therapy and actions aimed at maintaining the normal functioning of the cardiovascular system are indicated.

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Interactions with other drugs

Iso-mic can be used in complex therapy of cardiovascular diseases. Interaction with other drugs is possible with appropriate medical prescription.

• The drug may increase the toxicity of dihydroergotamine and increase its plasma concentrations.
• Contraindicated in combination with sildenafil and nitrates.
• Reduces the effectiveness of heparin and miotic agents.
• When used with sympathomimetics, the antianginal effect is reduced.
• Antihypertensive and vasodilatory agents, beta-adrenergic receptor and calcium channel blockers, tricyclic antidepressants, neuroleptics, ethyl alcohol and other medications enhance the hypotensive properties of isosorbide dinitrate.

When using solutions for intravenous administration, it is not recommended to use infusion systems made of polyvinyl chloride or polyurethane. Systems made of glass, polyethylene, and polytetrafluoroethylene are allowed.

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Storage conditions

All forms of Iso-mic according to storage conditions must be kept in the original packaging, away from open fire, protected from moisture and sunlight. The recommended storage temperature should not exceed 25 °C.

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Shelf life

Iso-mic in the form of a sublingual spray has a shelf life of 48 months from the date of manufacture. The injection solution, concentrate for the preparation of an infusion solution and tablets can be used for 36 months. After this period, the medicine is prohibited for use and must be disposed of.

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