Monit
✅ Enhances Heart Health
✅ Regulates Blood Pressure
✅ Reduces Cholesterol Levels
✅ Improves Circulatory System
✅ Supports Vascular Function
Momnit contains Isosorbide Mononitrate
✓ Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring · Laatst beoordeeld: mei 2026
⚡ Quick Answer — What is Monit?
Monit is een isosorbide mononitrate (ISMN) 20 mg tablet, used for the long-term prophylaxis of chronic stable angina. ISMN has 100% oral bioavailability (no first-pass metabolism), giving predictable dosing. The standard schedule is 20 mg twice daily with asymmetric timing — 7 a.m. and 2 p.m. — which preserves the overnight nitrate-free interval needed to avoid tolerance. Monit is niet a rescue medication; keep sublingual ISDN or nitroglycerin for acute attacks.
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Monit 20 mg is a tablet containing isosorbide mononitrate (ISMN), the active long-acting metabolite of isosorbide dinitrate. Because ISMN bypasses the liver’s first-pass metabolism, it achieves 100% oral bioavailability and a longer, more predictable duration of action than its parent compound — making it one of the most widely used oral anti-anginal agents worldwide.
Monit is indicated for the long-term prevention of angina episodes in patients with stable coronary artery disease. Many cardiologists choose ISMN over oral nitroglycerin SR or ISDN because of its cleaner pharmacokinetic profile and simple twice-daily schedule. It is often paired with a beta-blocker, a calcium channel blocker, or both, as part of a multi-drug anti-anginal regimen.
What Is Monit Used For?
- Long-term prophylaxis of chronic stable angina
- Effort-induced and mixed angina
- Post-myocardial-infarction angina prevention (alongside guideline-based secondary prevention)
- Variant (Prinzmetal) angina — second-line if calcium channel blocker alone is insufficient
- Heart failure with angina component — preload reduction, with specialist input
Monit is niet suitable for rescue therapy. Onset is 30–60 minutes. Every patient on Monit should carry a short-acting nitrate — sublingual nitroglycerin or sublingual isosorbide dinitrate (Sorbitrate) 5 mg — for acute attacks.
How Do Nitrates Work?
All nitrate medications share the same basic mechanism. Once absorbed, they are enzymatically converted into stikstofmonoxide (NO) inside vascular smooth muscle cells. NO activates guanylate cyclase, raising intracellular cGMP and relaxing the smooth muscle of blood vessels. The clinical effects are:
- Venous dilation (dominant at low doses) — reduces venous return to the heart, lowering preload. This is how nitrates reduce myocardial oxygen demand.
- Arterial dilation (higher doses) — reduces systemic vascular resistance and afterload, further cutting cardiac workload.
- Coronary artery dilation — improves blood flow to ischaemic regions of the heart muscle, especially in coronary spasm.
The net effect is less chest pain, fewer angina episodes, and improved exercise tolerance in patients with stable coronary artery disease.
Nitrate Tolerance — the Critical Dosing Rule
Nitrate tolerance is the single most important concept for any patient on a nitrate. If a nitrate is given around the clock — at steady blood levels for 24 hours a day — the anti-anginal effect fades within 48 to 72 hours. This is a well-documented, reproducible pharmacological phenomenon, not an imaginary effect.
The fix is simple and non-negotiable: every 24-hour cycle must include a nitrate-free interval of at least 8–12 hours, usually overnight. The standard strategies are:
- Asymmetric twice-daily dosing (e.g. 7 a.m. and 3 p.m., nothing after that until the next morning)
- Once-daily sustained-release formulations designed to deliver a low trough
- Removing a transdermal patch after 12–14 hours on the skin
Do niet take extra doses “at bedtime” or during the night unless your doctor explicitly prescribes round-the-clock therapy for a specific reason.
Monit Dosing
For chronic stable angina in adults:
- Startdosis: 20 mg in the morning for the first 2–4 days to reduce initial nitrate headache, then titrate up
- Usual maintenance: 20 mg twice daily on an asymmetric schedule — 7 a.m. and 2 p.m. — then nothing until the following morning. This gives roughly 7 hours of drug cover through the active day and 17 hours of nitrate-free interval overnight
- Titratie: Some patients need 40 mg twice daily; this is the upper end of immediate-release ISMN dosing
- Sustained-release formulations: If available (30–120 mg once daily), these deliver a single morning dose with a built-in low-trough overnight. Monit 20 mg is an immediate-release product, so it needs the twice-daily asymmetric schedule above
- Food: Monit can be taken with or without food; absorption is not significantly affected
Tablets should be swallowed whole. Do not chew or crush Monit tablets. If you miss a dose, take it when you remember unless your next dose is due within 3 hours — in that case skip it.
Starting dose-escalation rule to avoid intolerable headache: many cardiologists prescribe one 20 mg tablet daily for 3–4 days, then move to the twice-daily schedule once the patient is used to the vasodilator effect.
Who Should Not Take Monit?
There is one absolute contraindication that every patient must understand before the first dose:
Never combine any nitrate with a PDE5 inhibitor. Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra) potentiate the vasodilator effect of nitrates and can cause life-threatening hypotension, collapse, stroke, or myocardial infarction. Wait at least 24 hours after sildenafil/vardenafil en 48 hours after tadalafil before taking any nitrate dose. This applies to all forms — oral, sublingual, transdermal, and spray.
Other important contraindications:
- Severe hypotension or hypovolaemia (systolic BP < 90 mmHg)
- Severe anaemia (nitrates can worsen tissue oxygen delivery)
- Hypertrophic obstructive cardiomyopathy (HOCM) — nitrates can worsen outflow obstruction
- Severe aortic stenosis — risk of syncope
- Raised intracranial pressure or recent head trauma
- Right ventricular infarction — preload is essential, nitrates cut it
- Constrictive pericarditis or cardiac tamponade
- Known hypersensitivity to organic nitrates
- Concomitant soluble guanylate cyclase stimulators (riociguat)
Use with caution in pregnancy (category C) and discuss with a specialist. In breastfeeding, occasional use is generally accepted, but routine therapy should be reviewed with a cardiologist.
Common Side Effects of Monit
Most side effects of nitrates are direct extensions of their vasodilator action and tend to settle over the first 1–2 weeks of treatment.
Very common (>10% of patients):
- Hoofdpijn — throbbing, frontal, often worst in the first few days. Paracetamol is safe. Headache usually fades within 7–14 days as the body adjusts; it is niet a sign of overdose.
- Dizziness or light-headedness, especially on standing
- Facial flushing
Common (1–10%):
- Postural hypotension
- Reflex tachycardia (fast heart rate)
- Nausea, occasional vomiting
- Skin rash (more common with the transdermal patch)
Zeldzaam maar belangrijk:
- Syncope (fainting) — usually on the first dose, standing up, or after alcohol
- Paradoxical worsening of angina — rare; seek urgent review
- Methaemoglobinaemia — very rare, with sustained high-dose therapy
Stop the medication and contact your doctor urgently if you develop severe or persistent headache that does not settle, fainting episodes, a blistering rash, or blue-tinged lips and skin.
Monit vs Other Nitrates
Monit (ISMN) offers several advantages over older nitrates:
- vs ISDN (Sorbitrate): ISMN has 100% oral bioavailability (ISDN about 25%), more predictable blood levels, and a simpler dosing schedule. ISDN remains the first choice when sublingual use is needed for rescue
- vs Oral nitroglycerin SR (Angiplat, Angispan-TR): ISMN avoids the first-pass metabolism that makes oral nitroglycerin bioavailability variable. For simple daily prophylaxis, ISMN is often preferred
- vs Transdermal nitroglycerin (Nitroderm TTS): Patches are useful when oral therapy is not feasible (swallowing difficulty, nausea), but involve patch rotation, skin issues, and the need to remove at night. Tablets are simpler for most patients
What is the Asymmetric Dosing Schedule?
The “7 a.m. and 2 p.m.” schedule is the single most important practical detail of ISMN therapy. Here is why it matters:
- Immediate-release ISMN has a 4–6 hour duration of action
- Two doses 12 hours apart (e.g. 8 a.m. and 8 p.m.) would give continuous drug cover for 24 hours, which induces tolerance within 2–3 days
- Two doses 7 hours apart (7 a.m. and 2 p.m.) give cover until early evening and then a 17-hour nitrate-free trough overnight — which preserves sensitivity and ongoing effect
If your angina attacks happen in the evening or at night, speak to your cardiologist — a different nitrate or a different class of anti-anginal may be needed.
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Medisch disclaimer. The information on this page is provided for general education only. It is not a substitute for advice from your own doctor or cardiologist. Nitrates are potent cardiovascular medications with known serious interactions. Talk to a qualified healthcare professional before starting, stopping, or changing therapy, and seek immediate medical attention if chest pain is new, more severe, or lasts longer than 10–15 minutes.
Veelgestelde vragen
Can I use Monit to stop an angina attack?
No. Monit is a preventer with an onset of 30–60 minutes. To abort an attack, use sublingual nitroglycerin or sublingual isosorbide dinitrate (Sorbitrate) 5 mg — these act within 2–5 minutes.
Why is the second dose of Monit at 2 p.m. and not 8 p.m.?
Because without an overnight nitrate-free interval, your body develops tolerance and Monit stops working within 48–72 hours. The 7 a.m./2 p.m. schedule gives effective cover during active hours and restores sensitivity overnight.
Can I take Monit with sildenafil, tadalafil or vardenafil?
No — this combination is absolutely contraindicated. PDE5 inhibitors and nitrates can cause life-threatening hypotension. Allow 24 hours after sildenafil/vardenafil and 48 hours after tadalafil before any Monit dose.
Why do I get headaches on Monit?
Nitrate headache reflects cerebral vasodilation and is most intense in the first week. Many cardiologists start patients on 20 mg once daily for 3–4 days to build tolerance, then move to twice daily. Paracetamol is safe. Headache usually fades within 7–14 days.
Can I take Monit with a beta-blocker and a calcium channel blocker?
Yes, this is common triple anti-anginal therapy. The three classes work on different pathways and combine well, but blood pressure and heart rate should be checked in the first two weeks.
Can I take Monit at bedtime?
No. Bedtime dosing defeats the nitrate-free interval and causes tolerance. Keep the last dose in the early afternoon.
Is Monit safe long-term?
Yes, provided the asymmetric twice-daily schedule is maintained. Many patients stay on ISMN for years. Annual cardiology review is recommended.
What if I miss a Monit dose?
If it is still morning and you remember before lunchtime, take the missed dose. If you are close to or past the second scheduled dose, skip the missed dose and take the next scheduled dose as usual. Never double up.
Can I drink alcohol on Monit?
Light drinking with food is usually tolerated. Alcohol is a vasodilator and can amplify hypotension and dizziness, especially in the first hour after a dose. Heavy drinking should be avoided.
Can I drive while on Monit?
Yes, once stable and headache-free. Avoid driving in the first week of therapy, after any dose increase, or if you feel dizzy.
What is the difference between Monit and Sorbitrate?
Monit is isosorbide mononitrate (ISMN) — the active long-acting metabolite. Sorbitrate is isosorbide dinitrate (ISDN) — the parent compound. ISMN has 100% oral bioavailability and is simpler for chronic dosing. ISDN remains preferred when sublingual use is needed for acute attacks.
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| Sterkte | 20 mg |
|---|---|
| Hoeveelheid | 30 Tabletten, 60 Tabletten, 90 Tabletten, 180 Tabletten |
Monit
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