Last update Feb. 2, 2024

Isosorbide Mononitrate

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Isosorbide mononitrate is an active metabolite of the vasodilator isosorbide dinitrate. It is used in the treatment of angina pectoris, heart failure and pulmonary hypertension. Oral administration.

At the time of the last update, we found no published data on its excretion in breast milk.

If used during breastfeeding, it is advisable to monitor the infant for symptoms of drowsiness, lethargy or poor feeding and to monitor for weight gain. (Kearney 2018)

The amount of nitrate/nitrite in breast milk is not related to the level of nitrate ingested by the mother in water, food or medications (Paszkowski 1989). Ingestion of up to 100 mg/day of nitrate does not increase nitrate levels in breast milk. (Dusdieker 1996). For this reason, breastfed infants from regions with nitrate-contaminated water do not have an increased risk of methemoglobinemia, in contrast to bottle-fed infants. 

The amount of nitrate compounds contained in vasodilator drugs is so small that no nitrate toxicity problems, such as methemoglobinemia, have been reported in breastfed infants whose mothers used them.

Alternatives

  • Isosorbide Dinitrate (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Isosorbide Mononitrate in other languages or writings:

Group

Isosorbide Mononitrate belongs to this group or family:

Tradenames

Main tradenames from several countries containing Isosorbide Mononitrate in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 93 %
Molecular weight 191 daltons
Protein Binding 5 %
VD 0.7 l/Kg
pKa 13.34 -
Tmax 0.5 - 1 hours
4 - 5 hours

References

  1. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev. 2018 Abstract Full text (link to original source) Full text (in our servers)
  2. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  3. Dusdieker LB, Stumbo PJ, Kross BC, Dungy CI. Does increased nitrate ingestion elevate nitrate levels in human milk? Arch Pediatr Adolesc Med. 1996 Mar;150(3):311-4. Abstract
  4. Paszkowski T, Sikorski R, Kozak A, Kowalski B, Jakubik J. [Contamination of human milk with nitrates and nitrites]. Pol Tyg Lek. 1989 Nov 13-27;44(46-48):961-3. Polish. Abstract

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