Chemydur 60XL (Isosorbide mononitrate)

How does it work?

Chemydur 60XL tablets contain the active ingredient isosorbide mononitrate, which is a type of medicine called a nitrate. It is used to help the heart work more easily.

Isosorbide mononitrate works by being converted in the body to a chemical called nitric oxide. This chemical is made naturally by the body and has the effect of making the veins and arteries relax and widen (dilate). When the blood vessels dilate in this way there is more space inside them and hence less resistance. This makes it easier for the heart to pump blood around the body.

Widening the veins also decreases the volume of blood that returns to the heart with each heartbeat. This makes it easier for the heart to pump that blood out again.

As a result of both these actions, the heart does not need as much energy to pump the blood around the body and therefore needs less oxygen.

Isosorbide mononitrate also widens the arteries within the heart itself, which increases the blood and oxygen supply to the heart muscle.

The pain of angina is caused by too little oxygen reaching the heart when its workload increases, such as during exercise. Isosorbide mononitrate improves the oxygen supply to the heart, as well as decreasing the amount of oxygen that the heart needs by making it easier for the heart to pump blood around the body. It can therefore be used to treat angina.

Chemydur 60XL tablets are modified release tablets that are taken on a regular basis to help prevent angina attacks. The tablets are designed to release the medicine slowly as it passes through the gut. They are taken once a day, usually in the morning, to provide steady blood levels of the medicine throughout the day. The tablets must be swallowed whole and not chewed or crushed, as this would damage the modified release action.

What is it used for?

Prevention of angina attacks.

Warning!

This medicine should not be used to treat an angina attack, as it does not work quickly enough. It should be taken regularly, as prescribed, to prevent angina attacks, and you should keep your glyceryl trinitrate (GTN) sublingual tablets or spray with you at all times to use if you do have an angina attack.
This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
Drinking alcohol may enhance some of the side effects of this medicine, such as feeling faint or dizzy.
If you think that this medicine has become less effective at preventing angina attacks you should consult your doctor or pharmacist.
You should not suddenly stop taking this medicine, as this could cause your angina to get worse. If treatment with this medicine is stopped, this should be done gradually, following the instructions given by your doctor.

Use with caution in

Severely decreased kidney function.
Severely decreased liver function.
People who have recently had a heart attack.
Underactive thyroid gland (hypothyroidism).
People with low levels of oxygen in their blood, eg due to lung disease.
Dangerously low body temperature (hypothermia).
Malnutrition.

Not to be used in

Allergy to nitrates.
Low blood pressure (hypotension).
Low volume of circulating blood (hypovolaemia).
Inflammation of the sac surrounding the heart that stops the heart from beating properly (constrictive pericarditis).
Fluid in the sac surrounding the heart that prevents the heart beating properly (cardiac tamponade).
Narrowing of the main artery coming from the heart (aortic stenosis).
Narrowing of one of the valves in the heart (mitral valve stenosis).
Heart disease in which the muscle of the heart grows abnormally (hypertrophic obstructive cardiomyopathy).
Head injury.
Bleeding in the brain (cerebral haemorrhage).
Severe anaemia.
Closed angle glaucoma.
This medicine is not recommended for use in children.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine for use during pregnancy has not been established. It should only be used during pregnancy if the benefits to the mother outweigh any risks to the developing baby. Seek medical advice from your doctor.
It is not known if this medicine passes into breast milk. It should only be used by breastfeeding mothers if the benefits to the mother outweigh any risks to the nursing infant. Seek medical advice from your doctor.

Label warnings

This medication is to be swallowed whole, not chewed.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Headache.
Dizziness.
Weakness.
Nausea.
Flushing.
A drop in blood pressure that occurs when moving from a lying down or sitting position to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
Increased heart rate (tachycardia).
Decreased heart rate (bradycardia).
Allergic skin reactions.
Fainting.

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to ensure that the combination is safe.

The medicines for erectile dysfunction (impotence) listed below must not be used by people taking isosorbide mononitrate, because the combination can produce a severe drop in blood pressure resulting in dizziness, fainting, or even a heart attack:

sildenafil (Viagra)
tadalafil (Cialis)
vardenafil (Levitra).

If this medicine is used in combination with other medicines that reduce blood pressure, either as a treatment for high blood pressure (antihypertensives), or as a side effect, there may be an enhanced blood pressure lowering effect. This might make some people feel dizzy. If you do feel dizzy, you should lie down until the symptoms pass. Other medicines that can reduce blood pressure include the following:

ACE inhibitors, eg enalapril, captopril
alpha-blockers, eg alfuzosin, doxazosin
alprostadil
anaesthetics
angiotensin II receptor antagonists, eg losartan
certain antipsychotic medicines, eg chlorpromazine
baclofen
benzodiazepines, eg temazepam
beta-blockers, eg propranolol
calcium channel blockers, eg diltiazem, verapamil, nifedipine
clonidine
diuretics, eg furosemide
hydralazine
levodopa
MAOI antidepressants, eg phenelzine
methyldopa
minoxidil
moxisylyte
moxonidine
other nitrates, eg glyceryl trinitrate, amyl nitrate (poppers)
tricyclic antidepressants, eg amitriptyline.

Other medicines containing the same active ingredient

Cibral	Cibral XL	Elantan
Elantan LA	Imdur	Isib 60XL
Ismo	Ismo Retard	Isodur XL
Isotard XL	Modisal LA	Modisal XL
Monomax SR	Monomax XL	Monomil XL
Monosorb XL	Trangina XL	Xismox XL
Zemon XL

Isosorbide mononitrate tablets are also available without a brand name, ie as the generic medicine.