A-Card

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 it to be useful in aborting an acute anginal episode.

Tablet

The usual oral dose is 1 tablet (20 mg) twice daily — the first dose taken in the morning and the second dose taken 7 hours later. Maintenance doses may range from 20 mg to 120 mg (1–6 tablets). A starting dose of 10 mg (half a tablet) may be appropriate when a lower initial dose is required, or as directed by a registered physician.

Sustained Release Capsule

The usual oral dose is 1 capsule (50 mg) once daily, or as directed by a registered physician.

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, leading to dilatation of peripheral arteries and veins — particularly the veins. Venous dilatation promotes peripheral pooling of blood and reduces venous return to the heart, thereby lowering left ventricular end-diastolic pressure and pulmonary capillary wedge pressure (preload reduction). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload reduction). Dilatation of the coronary arteries also occurs. The relative contribution of preload reduction, afterload reduction, and coronary dilatation to the drug's therapeutic effect has not been fully established.

Headache, dizziness, and low blood pressure (hypotension) may occur.

• A-Card is contraindicated in patients with a known allergy to isosorbide mononitrate.
• Do not use in patients taking phosphodiesterase inhibitors for erectile dysfunction (e.g., sildenafil, tadalafil, or vardenafil). Concurrent use can cause severe hypotension, syncope, or myocardial ischemia.
• Do not use in patients taking the soluble guanylate cyclase stimulator riociguat. Concurrent use can cause hypotension.

Severe hypotension, particularly with upright posture, may occur even with small doses of A-Card. It should therefore be used with caution in patients who may be volume-depleted or who are already hypotensive for any reason. Hypotension induced by A-Card may be accompanied by paradoxical bradycardia and worsening of angina pectoris.

Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy.

In industrial workers with long-term exposure to high doses of organic nitrates, tolerance and physical dependence have been observed. Chest pain, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates in such individuals. The relevance of these findings to routine clinical use of oral A-Card is not established.

The antianginal efficacy of A-Card tablets is maintained by carefully following the prescribed dosing schedule — two doses taken seven hours apart. For most patients, this means taking the first dose on waking and the second dose 7 hours later.

As with other nitrates, daily headaches may accompany treatment with A-Card. In patients who experience these headaches, they serve as a marker of the drug's activity. Patients should not alter their dosing schedule to avoid headaches, as loss of headache may indicate loss of antianginal efficacy. Aspirin and/or acetaminophen can often relieve A-Card-induced headaches without affecting antianginal efficacy.

A-Card may cause light-headedness on standing, especially when rising from a lying or seated position. This effect may be more pronounced in patients who have also consumed alcohol.

Elderly Patients

Clinical studies of isosorbide mononitrate did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Other clinical experience has not identified differences in response between elderly and younger patients. However, dose selection for elderly patients should generally be cautious, starting at the lower end of the dosing range, given the greater likelihood of decreased hepatic, renal, or cardiac function and the presence of concomitant disease or other drug therapy.

Renal Impairment

The rate of clearance of isosorbide mononitrate is similar across patients with varying degrees of renal dysfunction. Dosage adjustment does not appear to be necessary in patients with renal impairment. Note that isosorbide mononitrate is significantly removed from the blood during hemodialysis; however, an additional compensatory dose is not considered necessary.

Hepatic Impairment

In patients with liver cirrhosis, pharmacokinetic parameters after a single dose of isosorbide mononitrate were similar to those observed in healthy volunteers. Dosage adjustment does not appear to be necessary in patients with hepatic impairment.

Pregnancy (Category B): Reproduction studies in rats and rabbits at doses up to 540 mg/kg/day and 810 mg/kg/day respectively showed no evidence of fetal harm due to isosorbide mononitrate. However, there are no adequate and well-controlled studies in pregnant women. Because animal studies are not always predictive of human response, isosorbide mononitrate should be used during pregnancy only if clearly needed.

Nursing Mothers: It is not known whether isosorbide mononitrate is excreted in human milk. Since many drugs are excreted in human milk, caution should be exercised when administering isosorbide mononitrate to a nursing woman.

The harmful effects of isosorbide mononitrate overdose result primarily from the drug's capacity to cause vasodilation, venous pooling, reduced cardiac output, and hypotension. Manifestations may include:

• Persistent throbbing headache, confusion, and moderate fever
• Vertigo and palpitations
• Visual disturbances
• Nausea, vomiting, and abdominal pain
• Syncope (fainting)
• Dyspnea (difficulty breathing) and air hunger
• Diaphoresis (profuse sweating)
• Heart block and bradycardia
• Paralysis, coma, and seizures
• Death in severe cases

In rare cases, organic nitrates including isosorbide mononitrate can produce methemoglobinemia, which may present with cyanosis (bluish discoloration of fingers, toes, or lips).

No specific antidote to the vasodilator effects of isosorbide mononitrate is known. Because the hypotension in overdose results from venous dilatation and reduced central fluid volume, treatment should be directed at increasing central fluid volume — passive elevation of the patient's legs may be sufficient, or intravenous infusion of normal saline may be required. Epinephrine and other arterial vasoconstrictors are not recommended and may worsen the condition. Methemoglobinemia, if it occurs, is treated with methylene blue 1–2 mg/kg administered intravenously.

• Concomitant use with phosphodiesterase inhibitors (in any form) is contraindicated.
• Concomitant use with riociguat, a soluble guanylate cyclase stimulator, is contraindicated.
• The vasodilating effects of A-Card may be additive with those of other vasodilators. Alcohol in particular has been shown to produce additive vasodilatory effects.
• Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates are used together. Dose adjustment of either agent may be necessary.

Store below 30°C, away from light and moisture. Keep out of the reach of children.

What is the price of A-Card 20 mg in Bangladesh (BD)?

A-Card 20 mg price in Bangladesh is ৳1.43 per tablet (৳143 per strip). Prices may vary by pharmacy and are updated regularly on this page.

What is A-Card used for?

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 it to be useful in aborting an acute anginal…

Is A-Card an antibiotic?

No, A-Card is not an antibiotic.