Isosorbide Mononitrate Tablets 40 mg should not be used in patients with marked anaemia, sever hypotension, closed angle glaucoma, toxic pulmonary oedema or hypovolaemia. This product should not be given to patients with a known hypersensitivity to isosorbide dinitrate or mononitrate, to other nitrates or to any of the excipients following a head trauma and including cerebral haemorrhage. Isosorbide Mononitrate Tablets 40 mg should not be used in cases of acute myocardial infarction with low filling pressures, acute circulatory failure (shock, vascular collapse), or very low blood pressure, hypertrophic obstructive cardiomyopathy (HOCM), constrictive pericarditis, cardiac tamponade, low cardiac filling pressures, aortic/mitral valve stenosis and diseases associated with a raised intra-cranial pressure e.g. It is recommended that the tablets should be swallowed whole with a drink of water. Both the dosage and frequency should be tapered gradually (see section 4.4) Treatment with Isosorbide Mononitrate Tablets, as with any other nitrates, should not be stopped suddenly. The safety and efficacy of Isosorbide Mononitrate Tablets 40 mg has yet to be established in children. No evidence of a need for routine dosage adjustment in older people has been found, but special care may be needed in those with increased susceptibility to hypotension or marked hepatic or renal insufficiency. The lowest effective dose should be used. The maintenance dose in individual patients is usually between 20- 120 mg daily. For patients not already receiving prophylactic nitrate therapy it is recommended that the initial dose be one tablet of Isosorbide Mononitrate Tablets 20 mg twice a day. Patients already accustomed to prophylactic nitrate therapy may normally be transferred directly to a therapeutic dose of isosorbide mononitrate. One tablet to be taken asymmetrically (to allow a nitrate low period) two or three times a day. Dosage should be reduced in patients with renal or hepatic impairment.
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