[Isosorbide-5-mononitrate (mono mac) in the prevention of bleeding from esophageal varicose veins in patients with liver cirrhosis]

Varicose esophageal veins bleeding is one of severe complications of hepatic cirrhosis. This complication is effectively managed with combination of beta-blockers with nitrates. Of the latter, optimal is isosorbite-5-mononitrate (mono mac). Its minimal risk of development of nitrate tolerance and pharmacokinetics does not depend on hepatic or renal function. A single dose of mono mac varies from 10 to 50 mg. The individual dose is selected by a fall in systolic blood pressure at rest (by 15-20 mm Hg) above 100 mm Hg. In appearance of serious headache nitrates are followed by beta-blockers monotherapy. It is inferred that isosorbite-5-mononitrate (mono mac) is effective in prophylaxis of hemorrhage from varicose veins of the esophagus both in beta-blockers and as monotherapy when beta-blockers are contraindicated.