isosorbide mononitrate 10 mg twice a day today and i have headaches - Heart Disorders Message Board

keith.uk · 11-24-2006, 05:34 PM

Hi i was put on this isosorbide mononitrate 10 mg twice a day today and i have headaches too and have just come out of hospital had this done angio-seal because i was getting bad chest pains what are you taking for the headaches so i can sort mine out please

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had angioplasty on the 7-09-06

had a pci + stent x1 to cx/ stent.drug eluting
all so have unstable angina

lanzoprazole 30mg
plavix clopidogrel 75mg
asprin 75mg
bisoprolol 10mg
simvastatin 80mg
isosorbide mononitrate 40mg twice a day
gtn spray

Lenin · 11-25-2006, 07:47 AM

There is no way around it...nitrates/nitrites cause headaches, sometimes slight othertimes murderously brutal.
The headache is caused by the expansion of the blood vessels of the lining of the brain...expansion = pressure = pain.

How about considereing a patch instead of a tablet...perhaps the absorption rate is lower at any given time?
My only personal experience is with .4 mg. sublingual nitroglycerine and recreational "poppers" from my mis-spent youth

. With the nitroglycerine, one pill fine, second pill iffy, third pill...OWWW, my HEAD! Yeah, the poppers for sex usually caused the same headache too.

For those who suffer too much from nitrates, perhaps beta-blockade is the better way to accomplish a similar result. Trying to medicate the pain away is the wrong approach because the only thing that will work is a vasoconstrictor and that's the LAST thing you want.

I DID find one correllation. Alcohol makes the nitrate headaches WORSE and more likely.

started04 · 11-27-2006, 11:06 AM

I take isosorbide and was told by doc and verified by pharmacist that the medication is coronary arteries specific for dilation. ACE inhibitor and coreg (beta blocker) are systematic vessel dilators. I inquired because it is for angina, and I didn't have angina! But to dilalte the corornary arteries may be beneficial even if there is no pain?!

I don't have any headaches, but your regimen greatly differs from mine. My regimen is a beta blocker (coreg), ACE inhibitor (lisinopril), lassix (diuratic), for contractions (digitek) and isosorbide to dilate coronary arteries.

Lenin · 11-28-2006, 06:55 AM

I just read an interesting case study of an elderly man who developed a predilection for CLUSTER headaches <sometimes called suicide headaches> after being introduced to isosorbide-mononitrate. WHen the drug was removed, the illness went away, when it was reintrduced, back came the headaches. In fact DURING the clusterr episode, which can go on for days, with EACH dose, the headache would return with a vengeance.

The discussion cleared up a mystery for me. I have occasional bouts with migraine/cluster and was always struck by the ease with which a known vasodilator caused splitting headaches but yet beta-blockers, KNOWN vasodilators are used to cure such headaches. There seemed to be a paradox.
The case study confirmed that the massive headache started just AFTER the effect of the nitrite peaked. My answer: the reactive vasoCONSTRICTION causes the pain.
Until I find better evidence, that will remain my hypothesis. If my theory is correct, then the SLOWER the nitrate/nitrite acts, the less likely the headache.

KK,

Quote:

I take isosorbide and was told by doc and verified by pharmacist that the medication is coronary arteries specific for dilation

I think this is a case, like the parallel with beta blockers, that the term "specific" can range from "sorta specific" to "very slightly specific."
Any reference to ISMN is ALWAYS accompanied by the caveat: "often causes hadache."

started04 · 11-28-2006, 11:47 AM

Quote:

The case study confirmed that the massive headache started just AFTER the effect of the nitrite peaked. My answer: the reactive vasoCONSTRICTION causes the pain.
Until I find better evidence, that will remain my hypothesis. If my theory is correct, then the SLOWER the nitrate/nitrite acts, the less likely the headache.

Lenin,

Recent reading states..."nitrates work by RELAXING blood vessels and increasing the supply of blood oxygen to the heart while reducing its workload". Relax and dilate may be a distinction without a difference, but another perspective for a headache (common to start, but less common after system adjusts) can be an effect on blood pressure and an increase of the pressure on the brain. For some, there is medication to lower BP and an antagonistic chemical agent that may increase pressure that may be disturbing. Nevertheless, Nitrates are contra-indicated for stroke victims as pressure can burst vulnerable brain vessels. Is it pressure that causes the headache? What is reactive recontriction?

Also it is recommended to take a nitrate dosage on an empty stomach with a full glass of water to increase the effect quicker and take another dose in about 8 hours. That is protocol for short acting nitrate, and recommended dose will have no effect on an occurring angina, but may prevent an event. There is another nitrate pill that for an extended release and it is higher dosage but only once a day for treating an occuring angina.