Monocard 20 mg Tablet

Long-acting nitrate for:

• Prevention of angina (not for treating an acute attack)
• Adjunct in chronic heart failure (with hydralazine in some patients)

Immediate release: 20 mg two to three times daily (asymmetric dosing, e.g. 8 am and 2 pm), up to 40 mg twice/three times daily — leaving a nitrate-free interval overnight.

Modified release: 30–60 mg once daily in the morning, increased to 120 mg if needed.

• Start low (e.g. 10–30 mg) to reduce headache.
• Swallow MR tablets whole with water.
• Use GTN spray for acute attacks.

• Use with PDE-5 inhibitors (sildenafil, tadalafil) or riociguat
• Severe low blood pressure, shock, hypovolaemia
• Hypertrophic obstructive cardiomyopathy, severe aortic/mitral stenosis, cardiac tamponade, constrictive pericarditis
• Severe anaemia, raised intracranial pressure
• Allergy to nitrates

Very common: headache (often settles in 1–2 weeks), dizziness, flushing.

Common: low blood pressure on standing, fast heartbeat, nausea, weakness.

Rare: fainting, worsening angina (paradoxical), rash.

• Do not stop suddenly (rebound angina).
• Stand up slowly; avoid alcohol.
• Tolerance develops if taken without a nitrate-free period.

Use in pregnancy only if clearly needed. Limited data in breastfeeding.

• Sildenafil, tadalafil, vardenafil, riociguat (contraindicated — severe hypotension)
• Other antihypertensives, alcohol, tricyclics (low blood pressure)

Severe headache, low blood pressure, fainting, fast heartbeat, methaemoglobinaemia. Lie flat with legs raised; emergency care.

Store below 30°C, protected from moisture.