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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Had 2nd Heart Attack. Given Isosorbide Mononitrate, Due To Shortness Of Breath Given Clopidogrel. Feel Weak. Side Effects?

hi I recently had a 2nd heart attack that couldn't have stents because vessels were on the small side. I was initially given isosorbide mononitrate, and ticagrelor. but after 4 weeks due to shortness of breath, 6 days ago I was taken off ticagrelor and put on clopidogrel. however whilst I now don't get the raging headaches of isosorbide mon I still have a clouded head feeling and feeling of weakness/dizziness. I take both tablets of a morning. could the clopidogrel be causing these side effects.
Tue, 30 Jul 2013
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General & Family Physician 's  Response
Hello,
Recently you had your 2nd Heart Attack. You were taking Isosorbide mono nitrate + Ticagrelor. For the last 6 days you are on Isosorbide mono nitrate + Clopidogrel. Even though you don't have the raging headache of Isosorbide still you have clouded head feeling + weakness + dizziness.
Clopidogrel does not produce symptoms as you mention. It is an Antiplatelet agent preventing the clotting mechanism. So bleeding anywhere in the body is the only major side effects.
The isosorbide mono nitrate produces dilatation of blood vessels leading to increased blood supply and little lowering of BP. If at all this drug may be the cause for your symptoms.
The tab Clopidogrel is a must and it is a single dose drug - better to have it in the afternoon 1/2 hour after lunch. Regarding isosorbide mono nitrate you can consult the Dr and ask for a change like asprin. Other drugs given for BP, Sugar or for any other purpose have to to be continued, and adhere to the diet strictly as advised by the Dr.
I hope you understand
With warm regards
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General & Family Physician Dr. Athish Peter Margos R's  Response
Hi,
Isosorbide nitrate causes vasodilation and can cause headache in the early part.But many patients do develop tolerance to this side effect and do not have problem in the later part.you seem to be in the process of developing tolerance.Juststick to it for a few more days and if you still dont find relief you can consider changing it over to some other nitrate as nitrocontin,but its efficacy will be lesser than you present drug.So just try for few more days.
It is very unlikely that clopidogrel is causing these side efffects.It is antiplatelet drug that prevents clotting and so most of the side effects are related to bleeding problems.As I said earlier isosorbide mono nitrate has more likely chance for these symptoms.Meanwhile do get your postural BP checked to rule out postural hypotension.
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Had 2nd Heart Attack. Given Isosorbide Mononitrate, Due To Shortness Of Breath Given Clopidogrel. Feel Weak. Side Effects?

Hello, Recently you had your 2nd Heart Attack. You were taking Isosorbide mono nitrate + Ticagrelor. For the last 6 days you are on Isosorbide mono nitrate + Clopidogrel. Even though you don t have the raging headache of Isosorbide still you have clouded head feeling + weakness + dizziness. Clopidogrel does not produce symptoms as you mention. It is an Antiplatelet agent preventing the clotting mechanism. So bleeding anywhere in the body is the only major side effects. The isosorbide mono nitrate produces dilatation of blood vessels leading to increased blood supply and little lowering of BP. If at all this drug may be the cause for your symptoms. The tab Clopidogrel is a must and it is a single dose drug - better to have it in the afternoon 1/2 hour after lunch. Regarding isosorbide mono nitrate you can consult the Dr and ask for a change like asprin. Other drugs given for BP, Sugar or for any other purpose have to to be continued, and adhere to the diet strictly as advised by the Dr. I hope you understand With warm regards