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Disclaimer: This information is for general guidance and does not replace medical advice from a pharmacist or doctor. For personalised advice, consult a healthcare professional and refer to the official leaflet that accompanies your medicine.

What is ismo (Isosorbide Mononitrate)?

Ismo, containing isosorbide mononitrate, is a medicine used to help prevent chest pain due to heart disease. It belongs to a class of medicines called nitrates. Nitrates work by relaxing and widening blood vessels, which can reduce the workload on the heart and improve blood flow to the heart muscle.

The medicine is available in several forms. It may come as tablets that you swallow and, in some preparations, as extended-release tablets that release the medicine gradually. The exact form and dose you are prescribed will depend on your condition and how your body responds to treatment. Always use the specific form prescribed for you and follow the instructions on the label or from your doctor.

In Ireland, whether you need a prescription for ismo depends on local rules. Check with your pharmacist or doctor if you are unsure. The product information leaflet and your healthcare professional can provide advice tailored to you. Keep this medicine out of reach of children and store it as directed on the packaging.

It is important to note that ismo is not a medicine for immediate relief of chest pain. It is taken regularly to help prevent angina episodes. If you experience chest pain that you think could be a heart attack, seek urgent medical help immediately, even if you are taking ismo.

What is it used for?

Ismo is used to prevent episodes of chest pain (angina) in people with coronary artery disease. By helping to relax blood vessels, it can reduce the frequency and intensity of angina attacks in some people.

It may be used as part of a broader treatment plan that includes other heart medicines and lifestyle changes, such as diet, exercise, and smoking cessation. Your doctor will determine the overall plan and adjust treatment based on how you respond and any side effects you may have.

Ismo is generally taken on a regular schedule to help control symptoms. It is not intended as a medicine to treat a chest pain attack that is already happening. If you have ongoing chest pain, or your chest pain changes in character or becomes more frequent, you should seek medical advice promptly.

Before starting ismo, tell your doctor about any other health conditions you have, including low blood pressure, anaemia, liver or kidney problems, or problems with your heart rhythm. This information helps your clinician decide if ismo is appropriate for you and whether a different treatment might be preferable.

How does ismo work?

Isosorbide mononitrate belongs to the nitrate family. It releases a substance called nitric oxide in the body, which relaxes the smooth muscles of blood vessels. This causes the veins and, to a lesser extent, the arteries to widen.

Widening of the blood vessels lowers blood pressure and reduces the amount of work the heart has to do to pump blood. This can lessen the frequency of angina episodes and improve blood flow to the heart muscle. Because tolerance can develop with long-term nitrate use, your doctor may manage dosing schedules to maintain effectiveness.

The effect of ismo on blood pressure and heart rate is typically monitored by your healthcare team. If you notice dizziness, lightheadedness, or a drop in blood pressure, tell your doctor, as adjustments to the treatment plan may be needed.

In some people, nitrates can interact with other medicines or health conditions. Always inform your clinician about all medicines you take, including over‑the‑counter drugs and herbal products, so they can assess for potential interactions.

How to use ismo (Isosorbide Mononitrate)

Take ismo exactly as prescribed by your doctor. Do not change the dose or frequency without medical advice. If you are uncertain, ask your pharmacist for clarification before starting or continuing treatment.

Swallow tablets whole with a full glass of water. Do not crush, chew, or break extended-release formulations unless your doctor or the product leaflet specifically instructs you to do so. The form you were prescribed determines how you should take it.

Take ismo consistently at the same times each day to help maintain an even level of medicine in your body. Do not skip doses or double up to make up a missed dose unless instructed by your healthcare professional. If you miss a dose, contact your pharmacist or doctor for advice on how to proceed.

Ismo should be part of a broader treatment plan for heart disease. It is important to continue other heart medicines as prescribed and to follow lifestyle recommendations from your healthcare team. Do not start or stop other medicines without checking with your doctor or pharmacist, as interactions can occur.

Storage and handling: Store at room temperature, away from moisture, heat, and sunlight. Keep the medicine in its original packaging until you are ready to use it. If the product has an expiry date, do not use it after that date. If you notice any changed colour, smell, or texture, or if the tablets appear damaged, talk to your pharmacist before using them.

Who should avoid ismo?

Do not take ismo if you have a known allergy to isosorbide mononitrate or other nitrates. An allergic reaction can be serious and requires urgent medical attention.

Avoid use if you have very low blood pressure or a sudden drop in blood pressure, known as hypotension, or if you have severe anaemia. In these situations, nitrates can cause dizziness, fainting, or other problems.

Certain medical conditions or upcoming procedures may require special care when taking nitrates. Tell your doctor if you have received recent head injury, brain surgery, or if you are planning surgery. They can advise on whether ismo should be paused before procedures.

If you are pregnant or breastfeeding, talk with your doctor about the risks and benefits of continuing ismo. Availability and safety in pregnancy may vary, and a healthcare professional can provide the most appropriate advice for your situation.

Warnings and safety information

Ismo can cause dizziness or lightheadedness, especially when standing up quickly. This is more common after starting treatment or after increasing the dose. Take time to sit or lie down if you feel dizzy and avoid sudden movements until symptoms pass.

Medicines in the same class (nitrates) and other medicines for blood pressure can interact with ismo and increase the risk of very low blood pressure. Tell your doctor about all medicines you take, including over-the-counter products and herbal supplements.

Alcohol can worsen dizziness or drop in blood pressure when you are taking ismo. Consider limiting alcohol intake and observe how you feel after drinking if you are not sure of the effect.

Your healthcare provider may recommend a nitrate-free interval, a period when the medicine is not taken each day, to reduce the chance of developing tolerance. Do not alter this interval without medical advice.

If you experience chest pain or symptoms suggesting a heart attack while taking ismo, seek urgent medical help and contact your doctor promptly. Do not assume it is a side effect of the medicine without medical assessment.

• Do not take with erectile dysfunction medicines (for example, those containing sildenafil) or certain other medicines used to treat chest pain, as this can cause dangerous drops in blood pressure.
• Do not stop taking the medicine suddenly unless advised by your doctor, as this may worsen angina symptoms or cause other effects.
• Inform your pharmacist or doctor if you are taking any medicines that affect blood pressure, heart rhythm, or fluid balance.
• Avoid using ismo in combination with medicines that cause significant drops in blood pressure without medical supervision.
• If you have liver or kidney problems, your doctor may adjust the treatment plan to reduce the risk of side effects.

Side effects

All medicines can cause side effects in some people. Commonly reported effects with ismo include headaches, dizziness, and flushing. These are usually mild and tend to improve with continued treatment or after adjusting the dose under medical supervision.

Less common side effects can include low blood pressure, fainting, nausea, and palpitations. If you notice severe or persistent symptoms, contact a healthcare professional for advice.

Some people may experience allergic-type reactions, such as skin rashes or swelling. Seek urgent medical help if you develop trouble breathing, swelling of the face or mouth, or severe skin reactions.

If you think you are having a serious reaction to ismo, stop taking it and seek immediate medical attention. Do not rely on self-treatment for serious symptoms.

• Headache
• Dizziness or lightheadedness
• Flushing (redness of the skin)
• Low blood pressure or fainting
• Nausea or heartburn
• Allergic reactions such as rash, itching, swelling

Interactions with other medicines

Tell your doctor about all medicines you take, including over-the-counter drugs, vitamins, and herbal supplements. Some medicines can interact with ismo and affect how it works or increase the chance of side effects.

Important interactions to discuss include other nitrates and medicines used for chest pain, erectile dysfunction drugs, and medicines that lower blood pressure. Combining these can cause a significant drop in blood pressure or other risks, so professional guidance is essential before starting or stopping any drug.

Some antibiotics, antifungal drugs, or medicines that affect liver enzymes can change how quickly ismo is processed in the body. Your doctor or pharmacist may adjust the plan if you start or stop such medicines. If you are taking any new medicine, check with a pharmacist before continuing ismo.

Always read the patient information leaflet for a complete list of interactions relevant to your product, and ask your pharmacist if you are unsure about any combination of medicines.

• Medications for erectile dysfunction (for example, sildenafil, tadalafil, vardenafil) or similar drugs
• Other medicines to treat high blood pressure or chest pain
• Medications that affect liver enzymes or are used to treat infections or fungal infections
• Herbal or supplement products that influence blood pressure or heart function

Pregnancy and breastfeeding

Safety in pregnancy and during breastfeeding is not fully established for all isosorbide mononitrate products. The decision to use this medicine during pregnancy should be made in consultation with a healthcare professional who can weigh the potential benefits against any risks.

If you are planning pregnancy, or you become pregnant while taking ismo, inform your doctor as soon as possible. They can advise whether to continue treatment or adjust your plan.

Breastfeeding considerations vary based on the formulation and individual circumstances. Discuss with your healthcare professional whether you should continue ismo during breastfeeding.

Always follow professional guidance and use the official patient information leaflet to help inform discussions with your clinician about pregnancy and breastfeeding safety.

Frequently asked questions

How quickly does ismo take effect?

The onset of effect depends on the product form and individual response. Ismo is generally used to prevent chest pain rather than to treat an immediate attack. If you have chest pain despite taking ismo as prescribed, seek medical advice promptly.

What should I do if I forget a dose?

If you miss a dose, do not double up to catch up. Take the next scheduled dose as instructed by your doctor or pharmacist. If you are unsure what to do, seek guidance from a healthcare professional to avoid potential problems.

Can I drink alcohol while taking ismo?

Alcohol can increase dizziness and the chance of low blood pressure in some people. It is reasonable to limit alcohol and to monitor how you feel after drinking. If you notice faintness or dizziness, contact your healthcare professional.

Can ismo be taken with other heart medicines?

Ismo is often prescribed alongside other heart medicines. Some combinations require particular monitoring or adjustments. Do not start or stop other heart medicines without talking to your doctor or pharmacist first.

Is it safe to drive or operate machinery while taking ismo?

If you experience dizziness, lightheadedness, or vision changes after taking ismo, you should avoid driving or operating heavy machinery until you know how the medicine affects you. Discuss any concerns with your doctor.

What if I have a very low blood pressure reading?

Very low blood pressure can cause fainting and accidents. If you feel unusually dizzy, lightheaded, or faint when standing, sit or lie down and seek medical advice. Do not take additional doses without consulting a professional.

Should I stop taking ismo during surgery or dental procedures?

During planning for surgery or dental procedures, inform your doctor that you are taking ismo. They may advise pausing the medicine for a period before procedures to reduce the risk of excessive blood pressure changes.

Can I give ismo to my child?

This medicine is prescribed for adults or for children only under the guidance of a pediatric specialist. Do not give ismo to a child without explicit medical advice.

How will my doctor know if ismo is working for me?

Your doctor will assess symptoms, frequency of chest pain, blood pressure, and heart rate. They may adjust the dose or treatment plan based on how you respond and any side effects you experience.

What should I do if I suspect an overdose?

If you think you have taken more than prescribed, seek medical help promptly. Do not wait for symptoms to develop. Contact a healthcare professional for specific instructions based on your situation.

Sources of information

This page summarises information from the product leaflet and standard medicines information resources used in clinical practice. It is intended to support discussions with your healthcare professionals and does not replace personalised medical advice.

For official guidance, refer to the patient information leaflet that accompanies the product and discuss any questions with your pharmacist or doctor. They can provide the most up-to-date and region-specific recommendations for Ireland.

In Ireland, guidance from the HPRA and guidance provided by registered healthcare professionals can help ensure safe and effective use of ismo. If you have concerns or need clarification, speak with a pharmacist about your individual circumstances.

If you need further clarification, your healthcare professional can help interpret this information in the context of your health needs and treatment goals.