Monotate

A-Card is indicated for the prevention and treatment of angina pectoris due to coronary artery disease. The onset of action of oral A-Card is not sufficiently rapid for A-Card to be useful in aborting an acute anginal episode.

Tablet
: The usual oral dose is 1 tablet (20 mg) 2 times daily, first dose in the morning and another 7 hours apart. Although maintenance doses ranging from 20 mg to 120 mg (1-6 tablets), a dose of 10 mg (1/2 tablet) is suitable when lower dosage is used at the starting of treatment or as directed by a registered physician.
Sustained Release Capsule
: The usual oral dose is 1 capsule (50 mg) daily or as directed by the registered physician.

Headache, feelings of dizziness, hypotension may occur sometimes.

Severe hypotension, particularly with upright posture, may occur with even small doses of A-Card. A-Card should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive. Hypotension induced by A-Card may be accompanied by paradoxical bradycardia and increased angina pectoris.
Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy. In industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs. Chest pain, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating the existence of true physical dependence. The importance of these observations to the routine, clinical use of oral A-Card is not known.
Patients should be told that the antianginal efficacy of A-Card tablets can be maintained by carefully following the prescribed schedule of dosing (two doses taken seven hours apart). For most patients, this can be accomplished by taking the first dose on awakening and the second dose 7 hours later.
As with other nitrates, daily headaches sometimes accompany treatment with A-Card. In patients who get these headaches, the headaches are a marker of the activity of the drug. Patients should resist the temptation to avoid headaches by altering the schedule of their treatment with A-Card, since loss of headache may be associated with simultaneous loss of antianginal efficacy. Aspirin and/or acetaminophen, on the other hand, often successfully relieve A-Card-induced headaches with no deleterious effect on A-Card’s antianginal efficacy.
Treatment with A-Card may be associated with light-headedness on standing, especially just after rising from a recumbent or seated position. This effect may be more frequent in patients who have also consumed alcohol.

Isosorbide mononitrate is the major active metabolite of isosorbide dinitrate (ISDN), and most of the clinical activity of the dinitrate is attributable to the mononitrate. The principal pharmacological action of isosorbide mononitrate is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins, especially the latter. Dilation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and  pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Dilatation of the coronary arteries also occurs. The relative importance of preload reduction, afterload reduction and coronary dilatation remains undefined.