Isosorbide Mononitrate
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Isosorbide mononitrate is a long-acting organic nitrate used for prophylaxis of angina pectoris. It is the active metabolite of isosorbide dinitrate with 100% oral bioavailability. The extended-release formulation (Imdur) is given once daily in the morning, with the built-in asymmetric dosing providing a nitrate-free interval to prevent tolerance.
Exploratory record, not a reviewed medical publication.
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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.
What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Isosorbide mononitrate is a long-acting organic nitrate used for prophylaxis of angina pectoris. NutriStack rates the supporting evidence as strong. Common adult dosing is IR: 20 mg twice daily (7 hours apart); ER: 30–240 mg once daily in the morning (as prescribed by your physician), though a prescriber sets the actual dose. This profile indexes 10 sources.
- Headache (most common, often diminishes over time)
- Dizziness
- Hypotension
- Concurrent PDE-5 inhibitor use (sildenafil, tadalafil, vardenafil)
- Concurrent riociguat
The bottom line
Evidence rating strong. Most-documented uses: effective prophylaxis of angina pectoris, 100% oral bioavailability (no first-pass metabolism), extended-release formulation allows once-daily dosing. 10 sources indexed (2009–2025), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Converted to nitric oxide (NO) in vascular smooth muscle. NO activates guanylyl cyclase, increasing cGMP levels and causing smooth muscle relaxation. Preferentially dilates venous capacitance vessels, reducing preload and left ventricular end-diastolic pressure. Also dilates coronary arteries and reduces afterload, decreasing myocardial oxygen demand.
Dosing & protocol.
Can be taken with or without food; 100% bioavailability; take in the morning; immediate-release doses should be taken 7 hours apart to allow nitrate-free interval
Full safety detail.
Side effects
- Headache (most common, often diminishes over time)
- Dizziness
- Hypotension
- Flushing
- Nausea
- Tolerance (mitigated by nitrate-free interval)
Contraindications
- Concurrent PDE-5 inhibitor use (sildenafil, tadalafil, vardenafil)
- Concurrent riociguat
- Severe hypotension
- Right ventricular infarction
- Hypertrophic obstructive cardiomyopathy
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
3- 1Efficacy and safety of isosorbide mononitrate plus misoprostol compared to misoprostol alone in the management of the first and second trimester abortion: a systematic review and meta-analysisPMIDMakvandi S, Karimi L, Safyari M et al. · BMC pregnancy and childbirth · 2024
Makvandi S, Karimi L, Safyari M et al.. Efficacy and safety of isosorbide mononitrate plus misoprostol compared to misoprostol alone in the management of the first and second trimester abortion: a systematic review and meta-analysis. BMC pregnancy and childbirth. 2024
- 2Compound Danshen Dripping Pills combined with isosorbide mononitrate for angina pectoris: A systematic review and a Meta-analysisPMIDWang R, Hu J, Li Y et al. · Chinese herbal medicines · 2024
Wang R, Hu J, Li Y et al.. Compound Danshen Dripping Pills combined with isosorbide mononitrate for angina pectoris: A systematic review and a Meta-analysis. Chinese herbal medicines. 2024
- 3Efficacy of beta-adrenergic blocker plus 5-isosorbide mononitrate and endoscopic band ligation for prophylaxis of esophageal variceal rebleeding: a meta-analysisPMIDDing SH, Liu J, Wang JP · World journal of gastroenterology · 2009
Ding SH, Liu J, Wang JP. Efficacy of beta-adrenergic blocker plus 5-isosorbide mononitrate and endoscopic band ligation for prophylaxis of esophageal variceal rebleeding: a meta-analysis. World journal of gastroenterology. 2009
Randomized controlled trials
2- 4Effects of Nicorandil, Isosorbide Mononitrate, or Diltiazem on Radial Artery Grafts After CABG: The Randomized ASRAB-Pilot TrialPMIDZhu Y, Zhang W, Qin K et al. · Circulation. Cardiovascular interventions · 2025
Zhu Y, Zhang W, Qin K et al.. Effects of Nicorandil, Isosorbide Mononitrate, or Diltiazem on Radial Artery Grafts After CABG: The Randomized ASRAB-Pilot Trial. Circulation. Cardiovascular interventions. 2025
- 5Long-acting cilostazol versus isosorbide mononitrate for patients with vasospastic angina: a randomized controlled trialPMIDKang MG, Ahn JH, Hwang JY et al. · Coronary artery disease · 2024
Kang MG, Ahn JH, Hwang JY et al.. Long-acting cilostazol versus isosorbide mononitrate for patients with vasospastic angina: a randomized controlled trial. Coronary artery disease. 2024
Reference material
5- 6Parker JD and Parker JO. Nitrate therapy for stable angina pectoris. N Engl J Med. 1998.Source linkedPMID
- 7Thadani U and Lipicky RJ. Short and long-acting oral nitrates for stable angina pectoris. Cardiovasc Drugs Ther. 1994.Source linkedPMID
- 8Abu-Zaid A et al. Isosorbide mononitrate for cervical ripening during labour induction: A systematic review and meta-analysis of 23 randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2022.Source linkedPMID
- 9Nyberg G. Clinical experience with Imdur in angina pectoris. A review. European journal of clinical pharmacology. 1990Source linkedPMID
- 10Gluud LL, Langholz E, Krag A. Meta-analysis: isosorbide-mononitrate alone or with either beta-blockers or endoscopic therapy for the management of oesophageal varices. Alimentary pharmacology & therapeutics. 2010Source linkedPMID
Common questions.
Quick answers about Isosorbide Mononitrate, drawn from the data on this page.
What is Isosorbide Mononitrate?
Isosorbide mononitrate is a long-acting organic nitrate used for prophylaxis of angina pectoris. It is the active metabolite of isosorbide dinitrate with 100% oral bioavailability. The extended-release formulation (Imdur) is given once daily in the morning, with the built-in asymmetric dosing providing a nitrate-free interval to prevent tolerance.
What is Isosorbide Mononitrate used for?
Commonly cited benefits of Isosorbide Mononitrate include: Effective prophylaxis of angina pectoris; 100% oral bioavailability (no first-pass metabolism); Extended-release formulation allows once-daily dosing; Built-in nitrate-free interval reduces tolerance. NutriStack rates the overall evidence as strong.
What is a typical dose of Isosorbide Mononitrate?
A typical adult dose of Isosorbide Mononitrate is IR: 20 mg twice daily (7 hours apart); ER: 30–240 mg once daily in the morning (as prescribed by your physician). The commonly recommended form is Extended-release tablet (Imdur) preferred for once-daily dosing. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Isosorbide Mononitrate?
Reported side effects include headache (most common, often diminishes over time), dizziness, hypotension, flushing, nausea, tolerance (mitigated by nitrate-free interval). This is educational information; check with a healthcare professional before use.
How strong is the evidence for Isosorbide Mononitrate?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
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