Complex therapy of chronic heart failure;
Prevention of attacks of stenocardia at patients with coronary heart disease, including during the period after a myocardial infarction.

Contraindications

Strict:

Age up to 18 years;
Need of co-administration of inhibitors of phosphodiesterase (for example, tadalafit, sildenafit or vardenafit) since they exponentiate hypotensive effect of nitrates;
Deficit of lactase, hereditary intolerance of a galactose, sprue of a galactose and glucose;
Severe form of anemia;
The expressed arterial hypotension (systolic arterial pressure less than 90 mm hg, diastolic – less than 60 mm hg);
Cardiogenic shock (if it is not possible to reach rather high end diastolic pressure in a left ventricle by means of intra aortal counterpulsation or by introduction of the means having positive inotropic effect);
The acute myocardial infarction which is followed by the expressed arterial hypotension;
Acute disorders of blood circulation (shock and vascular collapse);
Toxic fluid lungs;
Hypersensitivity to components of drug or nitrates.

With care:

Recently postponed craniocereberal injury;
Glaucoma;
Liver failure;
Heavy renal failure;
Aortal and/or mitral stenosis;
Low filling pressure at patients with an acute myocardial infarction, insufficiency of a left ventricle (it is impossible to allow decrease in systolic arterial pressure below 90 mm hg);
Tendency to orthostatic disturbances of vascular regulation;
Pericardium tamponade, chronic cardial compression, hypertrophic subaortic stenosis;
The diseases which are followed by the increased intracranial pressure;
Hemorrhagic stroke;
Thyrotoxicosis.

Route of administration and dosage

Monochinkva should accept inside after food, without chewing, washing down with enough water.

The doctor defines the mode of dosing and duration of therapy individually.

The initial recommended dose – on 20 mg (^1/2 tablets) 2 times a day. Further it is gradually raised to an optimum therapeutic dose – on 40 mg 2-3 times a day (bucketed 7-8 hours).

The highest resolved daily dose makes 120 mg.

Side effects

Very often (≥10%): a "nitrate" headache (arises in an initiation of treatment and usually passes within several days at treatment continuation);
Often (≥1% - <10%): a lowering of arterial pressure and/or development of orthostatic hypotension (after reception of the first dose and/or at the subsequent increase in a dose) that can be followed by dizziness, weakness and tachycardia; from a nervous system – an illegibility of visual perception, drowsiness, constraint of movements, reduction of speed of mental and motor reactions (especially in an initiation of treatment);
Seldom (≥0,1% - <1%): feeling of easy burning of language, nausea, face reddening, vomiting, allergic reactions, the expressed lowering of arterial pressure (is followed by weighting of symptoms of stenocardia), the kollaptoidny states which sometimes are followed by a faint and a bradyarrhythmia;
In some cases (<0,01%): exfoliative dermatitis.

Special instructions

Drug is not intended for stopping of bad attacks of stenocardia and treatment of an acute myocardial infarction.

During therapy it is necessary to control the arterial pressure and heart rate.

During pregnancy and a lactation to Monochinkva it can be applied strictly to destination the attending physician, after careful assessment of a ratio of the expected advantage and possible risks, under special medical control. At administration of drug by the feeding woman observation is necessary also for the child.

It is necessary to consider risk of development of tolerance to isosorbide-5-mononitrate or cross tolerance to other nitritsoderzhashchy connections. Not to allow such reaction, it is recommended to avoid long continuous reception to Monochinkva in high doses.

At patients with lability of blood circulation already at the first administration of drug development of symptoms of an acute circulatory unefficiency is possible.

Considerably it is possible to prevent "nitrate" headaches accepting at the beginning of therapy ½ tablets to Monochinkva 2 times a day – in the morning and in the evening.

It is not recommended to cancel sharply drug, it is necessary to reduce its dose gradually.

During therapy it is necessary to refrain from alcohol intake, and also to be careful when driving the car and performing the types of activity demanding the increased speed of reactions.

Medicinal interaction

Norepinephrinum (noradrenaline): its therapeutic effect decreases;
The adsorbents enveloping and astringents: mononitrate isosorbide absorption from digestive tract decreases;
M-holinoblokatory (including atropine): the risk of increase in intraocular pressure increases;
Beta адреностимуляторы, alpha adrenoblockers (dihydroergotamine): the anti-anginal effect to Monochinkva decreases that is shown by tachycardia and an excessive lowering of arterial pressure;
Blockers of slow calcium channels (for example, nifedipine, verapamil), propranolol, Amiodaronum: the anti-anginal effect to Monochinkva amplifies;
Vazopressora: their action decreases;
Barbiturates: metabolism accelerates and concentration of isosorbide of mononitrate in blood decreases;
Other vazodilatator, angiotensin-converting enzyme inhibitors, blockers of slow calcium channels, anti-hypertensive means, beta adrenoblockers, neuroleptics, tricyclic antidepressants, phosphodiesterase inhibitors (including vardenafit, sildenafit, tadalafit), ethanol: anti-hypertensive action to Monochinkva amplifies.