Imazin XL (discontinued in the UK- September 2005)

How does it work?

This medicine contains two active ingredients, isosorbide mononitrate and aspirin. Isosorbide mononitrate works by releasing a chemical (nitric oxide) which is also made naturally by the body. This chemical causes the veins and arteries to relax and widen so that, firstly, the blood supply to the heart is increased and secondly, the heart can pump blood around the body more easily. As a result, the pain of angina is prevented. Aspirin belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It works by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in the production of various chemicals in the body. These are known as prostaglandins, prostacyclins and thromboxane. In high doses, blocking cyclo-oxygenase prevents the production of prostaglandins. Prostaglandins are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and inflammation. High doses of aspirin are therefore used to relieve pain and inflammation. Aspirin in low doses (75mg) does not have this effect and is used instead as an anti-clotting or blood-thinning agent. In low doses, blocking cyclo-oxygenase prevents the production of thromboxane by blood cells called platelets. Thromboxane is one of the chemicals that causes platelets to clump together and start off the clotting process. Stopping its production therefore reduces the likelihood of clots forming in the blood. Clots in the blood can cause a heart attack or stroke, therefore low dose aspirin is used to prevent this in patients who are at risk.

What is it used for?

Angina pectoris

Prevention of further heart attacks following an initial heart attack

Warning!

You should consult your doctor if you are considering taking aspirin to reduce the risk of suffering a stroke or heart attack, to make sure it would be a suitable thing for you to do. Aspirin can actually increase the risk of a particular type of stroke in certain people, and it may also have side effects that outweigh its potential benefits for some people.

Children under 16 years of age should not take aspirin, unless on the advice of a doctor. This is because aspirin use in children has been associated with a rare condition called Reye's syndrome. This condition affects the brain and liver and though extremely rare, can be fatal. The causes of Reye's syndrome are not fully understood, but use of aspirin to treat fever in children with a virus has been implicated. There are many paracetamol and ibuprofen products not associated with Reye's syndrome available to treat pain and fever in this age group. For more advice talk to your pharmacist.

This medicine should not be used to treat an angina attack, as it does not work quickly enough. It should be used regularly, as prescribed, to prevent angina attacks, and you should keep your glyceryl trinitrate (GTN) sublingual tablets or spray with you at all times to use if you do have an angina attack.

Use with caution in

Allergic diseases

Closed angle glaucoma

Dangerously low body temperature (hypothermia)

Decreased kidney function

Decreased liver function

Hypothyroidism

Lack of the enzyme G6PD in the blood (G6PD deficiency)

Malnutrition

Not to be used in

Allergy to aspirin or other medicines in this class

Asthma

Bleeding disorders

Bleeding in the brain (cerebral haemorrhage)

Blood clotting disorder (haemophilia)

Children under 12 years of age

Head injury

Heart attack complicated by other heart problems

Low blood pressure (hypotension)

Low volume of circulating blood (hypovolaemia)

Peptic ulcer

Severe anaemia

Severely decreased blood supply through the vessels of the brain (cerebrovascular insufficiency)

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

The safety of this medicine in pregnancy is not established. It should be avoided, particularly in the third trimester. Seek medical advice from your doctor.

This medicine passes into breast milk. It is recommended that mothers should avoid using this medicine while breastfeeding. Seek medical advice from your doctor.

Label warnings

Take this medication with or after food.

This medication contains aspirin.

This medication is to be swallowed whole, not chewed.

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