Ranol SR is a specialized sustained-release formulation of isosorbide mononitrate, designed for the prophylactic management of chronic stable angina pectoris. As a long-acting organic nitrate, it provides a predictable and extended hemodynamic effect, reducing myocardial oxygen demand through venous and arterial dilation. This medication is indicated for patients requiring continuous nitrate therapy to prevent anginal attacks and improve exercise tolerance. Its sophisticated SR technology ensures stable plasma concentrations, minimizing the peaks and troughs associated with immediate-release formulations and offering a more consistent therapeutic profile for cardiovascular support.

Features

• Active ingredient: Isosorbide mononitrate 60mg
• Pharmaceutical form: Sustained-release tablet
• Mechanism: Prodrug converted to active metabolite isosorbide-5-mononitrate
• Duration of action: Up to 12 hours of continuous antianginal effect
• Pharmacokinetics: Gradual release profile with maximum concentration reached in 4-6 hours
• Bioavailability: Approximately 93% following oral administration
• Elimination half-life: 5-6 hours for the active metabolite
• Excretion: Primarily renal (95%) as inactive metabolites

Benefits

• Provides prolonged coronary vasodilation, reducing frequency and severity of anginal episodes
• Enhances exercise capacity and functional status in patients with chronic stable angina
• Offers simplified twice-daily dosing regimen compared to multiple daily doses of immediate-release formulations
• Maintains consistent therapeutic nitrate levels, minimizing breakthrough ischemia
• Demonstrates predictable hemodynamic effects with reduced development of tolerance
• Improves quality of life by allowing greater physical activity with reduced angina symptoms

Common use

Ranol SR is primarily prescribed for the prophylactic management of chronic stable angina pectoris in patients who require continuous nitrate therapy. It is particularly beneficial for individuals experiencing frequent anginal attacks that interfere with daily activities despite conventional antianginal therapy. The medication is commonly used as part of comprehensive cardiovascular management, often in combination with beta-blockers or calcium channel blockers when monotherapy provides insufficient symptom control. Clinical applications extend to patients with documented coronary artery disease who require long-term nitrate therapy for symptom management and functional improvement.

Dosage and direction

The recommended initial dosage for Ranol SR is one 60mg tablet taken orally twice daily, approximately 12 hours apart. Tablets should be swallowed whole with a full glass of water and must not be crushed, chewed, or divided. Administration should occur at the same times each day to maintain consistent plasma concentrations. The first dose is typically taken upon awakening and the second dose 12 hours later. For patients who experience headaches, dosage reduction to 30mg twice daily may be temporarily implemented before titrating back to the maintenance dose. Dosage adjustments should be made under medical supervision based on therapeutic response and tolerance.

Precautions

Patients should be advised that abrupt discontinuation of Ranol SR may precipitate rebound angina attacks. Headache is common during initial therapy but typically diminishes with continued treatment. Orthostatic hypotension may occur, particularly when rising quickly from sitting or lying positions. Alcohol consumption should be avoided as it may potentiate hypotensive effects. Caution is advised when operating machinery or driving until the patient’s response to therapy is established. Patients with hypovolemia or low systolic blood pressure (<90 mmHg) require careful monitoring. Periodic assessment of blood pressure and heart rate is recommended during therapy.

Contraindications

Ranol SR is contraindicated in patients with known hypersensitivity to organic nitrates or any component of the formulation. It must not be administered to individuals with severe anemia, increased intracranial pressure, or circulatory collapse. Concomitant use with phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil) is absolutely contraindicated due to risk of severe hypotension. The medication is contraindicated in patients with cardiogenic shock, marked hypotension, or conditions requiring high left ventricular filling pressure. It should not be used for treatment of acute angina attacks.

Possible side effects

The most frequently reported adverse reaction is headache (approximately 20% of patients), which is often dose-related and tends to decrease with continued therapy. Other common side effects include dizziness (4-8%), orthostatic hypotension (2-5%), and nausea (2-4%). Less frequently, patients may experience flushing, tachycardia, weakness, or syncope. Cutaneous vasodilation with flushing may occur in approximately 2% of patients. Rare adverse effects include methemoglobinemia, dermatitis, and gastrointestinal disturbances. Most side effects are dose-dependent and often diminish with continued treatment or dosage adjustment.

Drug interaction

Concomitant use with phosphodiesterase-5 inhibitors may cause severe hypotension and is absolutely contraindicated. Concurrent administration with other vasodilators, calcium channel blockers, antihypertensive agents, or tricyclic antidepressants may potentiate hypotensive effects. Alcohol may enhance the vasodilatory and hypotensive effects. Concurrent use with dihydroergotamine may increase ergotamine bioavailability. Aspirin may increase nitrate serum concentrations. Heparin effectiveness may be reduced when administered with nitrates. Beta-blockers and calcium channel blockers are often used concomitantly but require careful hemodynamic monitoring.

Missed dose

If a dose of Ranol SR 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 take a double dose to make up for a missed one. Maintaining consistent dosing intervals is crucial for maintaining therapeutic nitrate levels and preventing nitrate tolerance. If multiple doses are missed, patients should contact their healthcare provider for guidance on resuming therapy, as dosage adjustment may be necessary.

Overdose

Symptoms of Ranol SR overdose include severe hypotension, syncope, tachycardia, flushing, headache, dizziness, nausea, vomiting, and methemoglobinemia. In severe cases, cyanosis, apnea, seizures, or coma may occur. Management involves immediate discontinuation of the medication and supportive care. Elevation of lower extremities and administration of intravenous fluids are indicated for hypotension. Methylene blue (1-2 mg/kg intravenously) may be required for methemoglobinemia. Hemodialysis is not effective due to high protein binding. Vasopressors may be necessary in refractory cases of hypotension, though epinephrine is generally avoided.

Storage

Ranol SR tablets should be stored in their original container at controlled room temperature (20-25°C or 68-77°F). Protect from light, moisture, and excessive heat. Keep the container tightly closed and ensure the desiccant remains in the bottle. Do not transfer tablets to other containers. Keep out of reach of children and pets. Do not use tablets that show signs of discoloration, cracking, or other physical deterioration. Proper storage is essential for maintaining the integrity of the sustained-release formulation and ensuring consistent drug delivery.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Ranol SR is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to therapy may vary, and treatment decisions should be based on professional medical judgment. Patients should not alter their dosage or discontinue medication without consulting their physician. The manufacturer and distributors are not liable for any consequences arising from the use or misuse of this information.

Reviews

Clinical studies demonstrate that Ranol SR provides effective angina prophylaxis with 70-80% of patients showing significant reduction in anginal frequency and nitrate consumption. In a 12-week multicenter trial, patients experienced a mean reduction of 4.2 anginal attacks per week compared to baseline. Exercise tolerance testing showed average improvement of 1.5 minutes in time to onset of angina. Cardiologists report satisfactory therapeutic response in approximately 85% of patients with chronic stable angina, with particular appreciation for the consistent 12-hour dosing interval and reduced incidence of nitrate tolerance compared to immediate-release formulations.