Q. Can long term usage of Ismo trigger low blood pressure and vertigo?
Hello doctor, I am a 75-year-old male. I had IHD 40 years back. 23 years back, my doctor asked me to add Ismo 10 mg twice a day. Since then, I am taking it twice a day uninterruptedly. Then I was 54 years old. My BP has always been normal in all these years. Maybe 150/80 or 140/90 till a few years back. Now it is in normal level say 120/80, 120/73, 115/70, etc. Since a year, I am experiencing low blood pressure at times, giving me vertigo-like dizziness for 1 hour or 2 only in the early mornings and when I take Vertin, it subsides after 1 or 2 hours. Recently, I went to a well-known cardiologist in my area. He checked me and said that I have systemic hypertension and I need not take Ismo any longer as I do not need it. The BP at that time was 130/70. Before my going to the above cardiologist also I have experienced these levels like 120/70, 110/69, 125/75 likewise. He further said after stoppage of Ismo, the BP levels come to normal levels and I will not experience dizziness anymore. But, I am afraid of stopping the Ismo abruptly for fear of getting an anginal attack, which I have never experienced. I am afraid whether to ask my doctor about this. So, I have stopped taking one dose of Ismo 10 mg during the night. Slowly I shall stop the other doses also in due course. Kindly give me your valuable advice about Ismo, about stopping Ismo and dizziness. Is there any harm if I stop one dose? Does long usage of Ismo trigger low blood pressure and vertigo? Please enlighten me on this subject.
Hello. Firstly, Ismo (Isosorbide Mononitrate) is given for angina or chest pain. If one is not having it without Ismo then it may be stopped. So it is not an absolutely necessary medicine in absence of angina. Next thing, it can cause low BP, and low bp can cause dizziness. But, you mentioned, the lowest BP recorded was 110 systolic, and it is not too low to cause dizziness usually. Have you checked your BP while you being dizzy? So this BP can cause dizziness but not usually. Next thing, you said the response to Vertin (Betahistine), which is not likely in Ismo or hypotension induced dizziness. Vertin is for vertigo induced from the internal ear which is a very common problem. Also, importantly. dizziness induced by hypotension or Ismo will occur on standing or walking, but not while lying down or resting. So if it occurs on lying down as well or on neck movements then it is likely from the internal ear. Next, you should get one echo done to rule out the decrease in heart function as BP is remaining on the lower side. So overall, just go through the above description, and try to decide whether it is Ismo induced or from the internal ear, and you may stop Ismo as advised by the local cardiologist. Also, echo is necessary.