10 mg tablets
1. What Ismo is and what it is used for
Ismo contains isosorbide mononitrate which dilates the blood vessels and thereby reduces the work of the heart in angina pectoris.
Preventive treatment of angina pectoris ( angina pectoris ).
Isosorbide mononitrate contained in Ismo may also be approved for the treatment of other conditions not mentioned in this product information. Ask your doctor, pharmacist, or other healthcare professional if you have any further questions, and always follow their instructions.
2. What you need to know before taking Ismo
Do not take Ismo
- if you are allergic to isosorbide mononitrate or any of the other ingredients of this medicine (listed in section 6)
- if you are allergic to organic nitrates
- if you suffer from severe impaired blood circulation or shock
- if your heart has severely impaired pump function ( cardiogenic shock ), so that your blood pressure does not become high enough
- if you have decreased blood volume (severe hypovolemia )
- if you have pericarditis
- if you have accumulation of fluid in the pericardium around the heart ( cardiac tamponade )
- if you are also taking phosphodiesterase ‑5 ‑ inhibitors, e.g. sildenafil, vardenafil or taldalfil.
Warnings and cautions
Talk to your doctor or pharmacist before taking Ismo.
Consult a physician before starting treatment with Ismo if you:
- have hypertrophic obstructive cardiomyopathy (heart muscle disease)
- have low blood pressure
- have problems with low blood pressure , e.g. when getting up from sitting ( orthostatic circulatory dysregulation)
- have disease of the blood vessels in the brain ( cerebrovascular disease)
- have narrowing of the heart valves (aortic stenosis and / or mitral stenosis )
- has increased pressure in the skull
- have anemia ( anemia )
- have a lack of oxygenation of the blood ( hypoxemia )
- has impaired thyroid function
- is malnourished
- have low body temperature ( hypothermia )
- recently had a heart attack
- taking drugs to lower blood pressure et
Ismo is not suitable for the treatment of acute angina attack or heart attack.
Drugs of the phosphodiesterase -5 inhibitor type must not be taken at the same time as Ismo. Ingestion of Ismo within 24 hours after ingestion of phosphodiesterase -5 inhibitors should be done with caution due to the risk of severe hypotension.
Reduced effect of Ismo so-called tolerance development and that the reduced effect also applies to nitrates other than isosorbide mononitrate so-called cross-tolerance has been described.
If Ismo is taken, a transient lack of oxygenation of the blood ( hypoxemia ) may occur.
If you have coronary heart disease, it can lead to a lack of oxygen in the heart muscles.
The safety and efficacy of Ismo in children have not been established.
Other drugs and Ismo
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines.
Ismo must not be used at the same time as drugs of the phosphodiesterase -5 inhibitor type, e.g. sildenafil, vardenafil, and tadalafil as it can lead to a sharp drop in blood pressure, impaired blood supply ( ischemia ), and disturbed blood circulation with permanent damage to the heart and brain.
If you are taking the following medicines at the same time as Ismo, the blood pressure-lowering (hypotensive) effect of Ismo may be increased:
- other vasodilators (vasodilators)
- antihypertensives (medicines to treat high blood pressure ) e.g. ACE inhibitors , beta-blockers , calcium channel blockers and diuretics ( diuretics )
- neuroleptics (medicines for certain mental illnesses)
- sapropterin (drug used to lower the level of the amino acid phenylalanine in the blood of patients with phenylketonuria)
- tricyclic antidepressants (used for depression)
Ismo with alcohol
Concomitant treatment with Ismo and alcohol consumption may potentiate the antihypertensive effect of Ismo.
Pregnancy and breastfeeding
If you are pregnant or breastfeeding, think you may be pregnant, or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.
Limited experience of use during pregnancy. Therefore consult a doctor before using Ismo during pregnancy.
It is not known if Ismo passes into breast milk. Therefore consult a doctor before use during breastfeeding.
Driving and using machines
Ismo may impair the ability to react. This should be taken into account when increased attention is required, eg when driving or using machines. This applies above all at the beginning of the treatment or when the treatment is changed and in connection with alcohol.
You are responsible for assessing whether you are fit to drive a motor vehicle or perform work that requires sharpened attention. One of the factors that can affect your ability in these respects is the use of drugs due to their effects and/or side effects. Descriptions of these effects and side effects can be found in other sections. Read all the information in this leaflet for guidance. If you are not sure, talk to your doctor or pharmacist.
Ismo contains milk sugar (lactose)
Ismo contains 74 mg of milk sugar ( lactose ) per tablet.
If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
3. How to take Ismo
Always take this medicine exactly as your doctor or pharmacist has told you. Ask your doctor or pharmacist if you are unsure.
Dose one is determined by the doctor who adjusts it individually for you.
The recommended dose is two 10 mg tablets in the morning and the afternoon with food. Dose one can be increased to four 10 mg tablets twice daily if needed.
To avoid headaches, it is recommended to start with a 10 mg tablet twice daily for the first 2 days of treatment.
Discontinuation of Ismo treatment should be gradual so that the symptoms of angina do not worsen.
The tablets should not be chewed but swallowed whole with liquid (eg a glass of water) with a meal.
If you take more Ismo than you should
If you have ingested too much medicine or if e.g. If a child has inadvertently ingested the medicine, contact a doctor, hospital, or the Poison Information Center for risk assessment and advice.
Symptoms of overdose may include : decreased blood pressure with impaired blood circulation ( orthostatic dysregulation), increased heart rate (reflex tachycardia), palpitations ( palpitations ), pulsating headache, anxiety ( excitation ), reddening of the skin, cold sweats, weakness ( asthenia ), dizziness, dizziness stupor ), fainting, nausea, vomiting and diarrhea.
If you forget to take Ismo
Do not take a double dose to make up for a forgotten tablet.
If you forget to take a tablet, take it the same day as soon as you remember. Continue treatment as usual the next morning.
If you stop taking Ismo
You may feel unwell if you suddenly stop taking Ismo. Tell your doctor if you stop taking this medicine.
If you have any further questions on the use of this product, ask your doctor or pharmacist.
4. Possible side effects
Like all medicines, this medicine can cause side effects , although not everybody gets them.
Very common (may affect more than 1 user in 10)
- headache (so-called “nitrate headache”). Occurs frequently at the beginning of treatment and usually disappears after a few weeks of treatment.
Common (may affect up to 1 in 10 people)
- low blood pressure ( hypotension )
- elevated heart rate ( tachycardia )
Uncommon (may affect up to 1 in 100 people)
- transient redness ( erythema )
Rare (may affect up to 1 in 1,000 people)
- allergic skin reactions
Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This also applies to any side effects not mentioned in this information. You can also report side effects directly to the Medical Products Agency. By reporting side effects, you can help increase drug safety information.
5. How to store Ismo
Keep this medicine out of the sight and reach of children.
Used before the expiry date which is stated on the carton. The expiration date is the last day of the specified month.
Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
6. Contents of the packaging and other information
- The active substance is isosorbide mononitrate 10 mg per tablet.
- The other ingredients are anhydrous lactose 74 mg, colloidal anhydrous silica, magnesium stearate.
What the medicine looks like and contents of the pack
100 tablets (white, round, marked ISMO / 10)
Marketing Authorization Holder and Manufacturer
Holder of a marketing authorization
Riemser Pharma GmbH
An der Wiek 7
DE-17493 Greifswald – Insel Riems
Kern Pharma SL
Polygono Ind. Colon II
08228 Terrassa (Barcelona)