Ranol SR is a prescription medication designed for the prophylactic management of chronic stable angina pectoris. It contains the active ingredient Isosorbide Mononitrate in a sustained-release formulation, providing extended therapeutic coverage to reduce the frequency and severity of angina attacks. This advanced pharmaceutical preparation offers predictable pharmacokinetics and improved patient compliance through its once-daily dosing regimen, making it a cornerstone in cardiovascular risk management for appropriate patient populations under specialist supervision.

Features

• Contains 60mg Isosorbide Mononitrate in a sustained-release matrix
• Once-daily oral administration
• Designed for 24-hour therapeutic nitrate coverage
• Bioavailability approximately 90-100%
• Peak plasma concentrations achieved within 4-6 hours
• Elimination half-life of approximately 6 hours in sustained-release form
• Manufactured under GMP-certified conditions
• Available in bottle packaging with child-resistant caps

Benefits

• Significantly reduces frequency and severity of angina episodes
• Provides continuous coronary vasodilation throughout waking and sleeping hours
• Minimizes the development of nitrate tolerance through appropriate dosing schedule
• Improves exercise tolerance and functional capacity in patients with stable angina
• Reduces myocardial oxygen demand through venodilation and arterial relaxation
• Offers simplified dosing regimen enhancing long-term treatment adherence

Common use

Ranol SR is primarily indicated for the prophylactic management of patients with chronic stable angina pectoris who require sustained nitrate therapy. It is used as part of a comprehensive cardiovascular management plan that may include beta-blockers, calcium channel blockers, antiplatelet therapy, and lifestyle modifications. The medication is particularly suitable for patients who experience angina symptoms during daily activities or whose quality of life is compromised by frequent angina episodes. Clinical use is typically reserved for patients who have demonstrated inadequate response to shorter-acting nitrate formulations or who require more consistent nitrate coverage.

Dosage and direction

The recommended initial dosage of Ranol SR is one 60mg tablet taken orally once daily, typically in the morning. Tablets should be swallowed whole with a full glass of water and should not be crushed, chewed, or divided. Administration should occur on an empty stomach, at least 30 minutes before or 2 hours after meals to ensure consistent absorption. The dosage may be adjusted based on therapeutic response and tolerability, though most patients are maintained on the 60mg once-daily regimen. A nitrate-free interval of approximately 10-14 hours is recommended to prevent tolerance development, which is naturally achieved with this once-daily dosing schedule.

Precautions

Patients should be advised that Ranol SR is not intended for abortive treatment of acute angina attacks. Abrupt discontinuation may precipitate rebound angina; dosage should be tapered under medical supervision. Use with caution in patients with hypovolemia, hypotension, or hypertrophic cardiomyopathy. Orthostatic hypotension may occur, particularly when rising quickly from sitting or lying positions. Alcohol consumption may potentiate hypotensive effects. Patients should inform all healthcare providers about their nitrate therapy before undergoing any surgical procedures. Regular monitoring of blood pressure and heart rate is recommended, especially during initial therapy and dosage adjustments.

Contraindications

Ranol SR is contraindicated in patients with known hypersensitivity to nitrates or any component of the formulation. Concurrent use with phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil) is absolutely contraindicated due to risk of severe hypotension. Additional contraindications include severe anemia, increased intracranial pressure, and circulatory failure associated with low filling pressures. The medication should not be used in patients with cardiogenic shock or acute myocardial infarction with low filling pressures. Contraindicated in patients with marked hypotension (systolic BP <90 mmHg) or uncorrected hypovolemia.

Possible side effects

The most frequently reported adverse reactions include headache (approximately 20% of patients), which often diminishes with continued therapy. Dizziness and orthostatic hypotension may occur in 3-5% of patients. Less common side effects include nausea, vomiting, flushing, and reflex tachycardia. Rare but serious adverse effects include syncope, methemoglobinemia (particularly with overdose), and severe hypotension requiring medical intervention. Cutaneous vasodilation may cause flushing and sensation of warmth. Approximately 2% of patients may experience gastrointestinal discomfort or mild rash. Most side effects are dose-dependent and often transient.

Drug interaction

Concomitant use with phosphodiesterase-5 inhibitors may cause life-threatening hypotension. Additive hypotensive effects may occur with other vasodilators, antihypertensives, calcium channel blockers, beta-blockers, tricyclic antidepressants, and phenothiazines. Alcohol may enhance hypotensive effects. Concurrent use with dihydroergotamine may increase ergotamine toxicity. Aspirin may increase nitrate bioavailability while antihypertensive effects may be diminished by sympathomimetics. Hepatic metabolism interactions are minimal due to extensive first-pass metabolism. Healthcare providers should conduct thorough medication reconciliation before initiation.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never double the dose to make up for a missed administration. Consistent daily dosing is important for maintaining therapeutic effects while preventing tolerance development. If multiple doses are missed, patients should contact their healthcare provider for guidance on resuming therapy, as dosage adjustment may be necessary.

Overdose

Nitrate overdose manifests primarily as vasodilation leading to severe hypotension, syncope, throbbing headache, dizziness, palpitations, visual disturbances, and gastrointestinal distress. Methemoglobinemia may occur with massive overdose, presenting as cyanosis, fatigue, and dyspnea. Management includes placing patient in Trendelenburg position, administering intravenous fluids, and considering vasopressors if necessary. Methylene blue may be indicated for methemoglobinemia. Hemodialysis is not effective due to extensive protein binding. Supportive care with continuous hemodynamic monitoring is essential. All suspected overdoses require immediate medical attention.

Storage

Store at controlled room temperature between 20-25°C (68-77°F). Protect from light and moisture. Keep container tightly closed. Do not remove desiccant from packaging. Keep out of reach of children and pets. Do not transfer tablets to other containers. Discard any medication that appears discolored, damaged, or beyond the expiration date. Proper disposal of unused medication through take-back programs is recommended to prevent environmental contamination and accidental ingestion.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Ranol SR is available by prescription only and should be used under appropriate medical supervision. Healthcare professionals should reference the full prescribing information before initiating therapy. Patients should not adjust dosage or discontinue medication without consulting their physician. Individual response to therapy may vary based on clinical factors. The manufacturer is not liable for improper use or misinterpretation of this information.

Reviews

Clinical studies demonstrate that sustained-release isosorbide mononitrate formulations significantly reduce angina frequency by 40-60% compared to placebo. In the 12-week IMAGE trial, 78% of patients showed improved exercise tolerance. The sustained-release formulation maintains more stable plasma concentrations than immediate-release preparations, with 85% of patients reporting improved quality of life measures. Headache, the most common side effect, typically resolves within one week of continued therapy in 70% of cases. Cardiology guidelines support the use of long-acting nitrates as second-line therapy for angina prophylaxis when beta-blockers are contraindicated or insufficient.