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Angiofox® (Effox®) - Isosorbide Mononitrate
Summary
Angiofox (also known as Effox) is a medication used for the long-term management of heart-related conditions, primarily coronary artery disease and the prevention of angina pectoris (chest pain). Its active ingredient, Isosorbide-5-Mononitrate, is a nitrate that works by relaxing and widening blood vessels (vasodilation). This action reduces the strain on the heart and improves blood flow to the heart muscle, helping to prevent anginal attacks. It is not intended for the immediate relief of an acute angina attack.
Manufacturer & Licensing
- Manufactured by: MINAPHARM, Egypt.
- Under licence of: SCHWARZ PHARMA, Germany.
Category & Active Ingredient
- Category: Antianginal Agent, Vasodilator (Nitrate).
- Active Ingredient: Isosorbide-5-Mononitrate.
Available Forms & Strengths in Egypt
Angiofox (Effox) is available in various formulations to allow for flexible dosing and sustained effects:
- Angiofox 20 mg Tablets: Standard immediate-release tablets.
- Angiofox 40 mg Tablets: Higher strength immediate-release tablets.
- Angiofox 25 mg Long Capsules: Sustained-release (long-acting) formulation.
- Angiofox 50 mg Long Capsules: Higher strength sustained-release (long-acting) formulation.
Properties and Mechanism of Action
Isosorbide-5-Mononitrate is an organic nitrate that acts as a potent vasodilator. It works by releasing nitric oxide (NO) in the smooth muscle of blood vessels. This leads to the relaxation of these muscles, causing both arteries and veins to widen. By dilating the veins, it reduces the amount of blood returning to the heart (preload). By dilating the arteries, it reduces the pressure the heart has to pump against (afterload). Both effects decrease the workload and oxygen demand of the heart muscle, which is the primary mechanism for preventing angina pectoris.
Indications for Angiofox (Effox)
This medication is indicated for the long-term management of several cardiovascular conditions:
- Long-term treatment of coronary artery disease.
- Prevention and long-term treatment of angina pectoris.
- Adjunctive long-term treatment of chronic heart failure (in combination with other standard therapies like cardiac glycosides, diuretics, or ACE inhibitors).
- Management of pulmonary hypertension (high blood pressure in the lungs).
Dosage and Administration
Dosage should be determined by a physician. A key principle of nitrate therapy is to allow for a "nitrate-free" interval each day to prevent the development of tolerance.
- Standard Tablets (e.g., 40 mg): A common regimen is one tablet taken once or twice daily. If taken twice, the second dose should be administered about 8 hours after the first, not 12, to ensure a nitrate-low period.
- Long Capsules: Typically taken once daily in the morning.
- Administration: Swallow the tablet or capsule whole with sufficient fluid. Do not chew.
Side Effects
Side effects are common, especially at the beginning of treatment.
- Very Common: A "nitrate headache" is the most frequent side effect, affecting more than 10% of patients. It usually diminishes with continued use.
- Common: Dizziness, drowsiness, a feeling of weakness, and a drop in blood pressure upon standing (orthostatic hypotension), which may be accompanied by a reflex increase in heart rate.
- Uncommon: Nausea, vomiting, flushing, and allergic skin reactions (e.g., rash). Collapse, sometimes with a slow heart rate, can occur.
- Very Rare: Severe skin conditions like Stevens-Johnson syndrome, angioedema.
Contraindications
Do NOT use Angiofox (Effox) if you have:
- Known hypersensitivity to isosorbide mononitrate or other nitrates.
- Acute circulatory failure (shock, collapse).
- Very low blood pressure (systolic pressure below 90 mmHg).
- Cardiogenic shock.
- Crucially, you must not use this medication if you are taking phosphodiesterase-5 (PDE-5) inhibitors such as sildenafil (Viagra®), tadalafil, or vardenafil, as this combination can cause a life-threatening drop in blood pressure.
Drug Interactions
- PDE-5 Inhibitors (e.g., Sildenafil): Absolutely contraindicated. Can lead to severe, life-threatening hypotension.
- Blood Pressure Lowering Agents: The hypotensive effect is increased when taken with beta-blockers, calcium channel antagonists, other vasodilators, neuroleptics, or tricyclic antidepressants.
- Alcohol: Potentiates the blood pressure-lowering effect of the medication.
- Dihydroergotamine: May increase the blood level and hypertensive effect of dihydroergotamine.
Precautions & Warnings
- Tolerance: To prevent a decrease in effectiveness (tolerance), continuously high dosages should be avoided, and a nitrate-free interval should be maintained daily.
- Acute Angina Attack: This medication is for prevention, not for treating an acute attack of chest pain.
- Driving and Operating Machinery: The medication can impair reactivity, especially when combined with alcohol.
- Use with caution in patients with certain heart conditions like hypertrophic obstructive cardiomyopathy (HOCM) or aortic/mitral stenosis.
Frequently Asked Questions (FAQ)
Why is this medication called both Angiofox and Effox?
Effox is the original brand name from the German licensor, Schwarz Pharma. Angiofox is the brand name under which Minapharm markets the product in Egypt. They contain the same active ingredient.
Why can't I take this with drugs like sildenafil (Viagra®)?
Both medications are potent vasodilators. Taking them together causes a synergistic and drastic drop in blood pressure, which can be fatal. Patients on nitrate therapy must be strictly warned against using PDE-5 inhibitors.
What is a "nitrate headache"?
It's a very common side effect caused by the widening of blood vessels in the head. It's often most intense at the start of therapy and typically subsides as the body gets used to the medication. Over-the-counter painkillers may help, but consult your doctor.
References
- British National Formulary (BNF) - NICE: For professional information on Isosorbide Mononitrate. Isosorbide Mononitrate - NICE
- European Medicines Agency (EMA): For regulatory information and Summaries of Product Characteristics. EMA Website
- Product Information: Key information is also sourced from the internal leaflet provided by Minapharm under licence of Schwarz Pharma.
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