• Effox indications
• Uses of Effox in details
• Effox description
• Effox dosage
• Effox interactions
• Effox side effects
• Effox contraindications

What is Effox?

Effox is in a group of drugs called nitrates. Effox dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump.

Effox is used to prevent angina attacks (chest pain).

Effox will not treat an angina attack that has already begun.

Effox may also be used for purposes not listed in this medication guide.

Effox indications

The recommended regimen of Effox tablets is 20 mg (one tablet) twice daily, with the two doses given 7 hours apart. For most patients, this can be accomplished by taking the first dose on awakening and the second dose 7 hours later. Dosage adjustments are not necessary for elderly patients or patients with altered renal or hepatic function. As noted above (CLINICAL PHARMACOLOGY), multiple studies of organic nitrates have shown that maintenance of continuous 24-hour plasma levels results in refractory tolerance. The dosing regimen for Effox tablets provides a daily nitrate-free interval to avoid the development of this tolerance.

As also noted under CLINICAL PHARMACOLOGY, well-controlled studies have shown that tolerance to Effox tablets is avoided when using the twice-daily regimen in which the two doses are given 7 hours apart. This regimen has been shown to have antianginal efficacy beginning 1 hour after the first dose and lasting at least 5 hours after the second dose. The duration (if any) of antianginal activity beyond 12 hours has not been studied; large controlled studies with other nitrates suggest that no dosing regimen should be expected to provide more than about 12 hours of continuous antianginal efficacy per day.

In clinical trials, Effox tablets have been administered in a variety of regimens. Single doses less than 20 mg have not been adequately studied, while single doses greater than 20 mg have demonstrated no greater efficacy than doses of 20 mg.

How should I use Effox?

Use Effox sustained-release tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Effox sustained-release tablets by mouth with or without food.
• Swallow Effox sustained-release tablets whole. Do not break, crush, or chew before swallowing. Some strengths of Effox sustained-release tablets may be broken in half. If you have difficulty swallowing the tablet whole, ask your pharmacist if your strength of medicine may be broken in half.
• Take Effox sustained-release tablets with one-half glass of water or other liquid.
• Do not suddenly stop taking Effox sustained-release tablets. You may have an increased risk of side effects (eg, an angina attack). If you need to stop Effox sustained-release tablets or add a new medicine, your doctor will gradually lower your dose.
• If you miss a dose of Effox sustained-release tablets, take it as soon as possible. If it is late in the day, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Effox sustained-release tablets.

Uses of Effox in details

Use: Labeled Indications

Angina pectoris: Treatment (immediate-release only) and prevention of angina pectoris caused by coronary artery disease. Note: The onset of action of oral Effox is not sufficiently rapid for this product to be useful in aborting an acute anginal episode.

Off Label Uses

Heart failure with reduced ejection fraction (HFrEF)

Based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines for the management of heart failure, isosorbide dinitrate (in combination with hydralazine) is effective and recommended as additional therapy to optimal guideline directed medical therapy for self-identified African-American patients with persistent NYHA class III or IV HFrEF or for patients who do not tolerate an ACE inhibitor or an angiotensin II receptor blocker (ARB). Some experts recommend isosorbide dinitrate (in combination with hydralazine) in addition to optimal guideline-directed medical therapy for black and nonblack patients with persistent NYHA class III or IV HFrEF, particularly for those with low output states or hypertension, or for patients who do not tolerate an ACE inhibitor, ARB, or angiotensin II-neprilysin inhibitor (ARNI). In order to improve compliance, it may be reasonable to replace isosorbide dinitrate with Effox (in combination with hydralazine).

Effox description

Effox is a drug used principally in the treatment of angina pectoris and acts by dilating the blood vessels so as to reduce the blood pressure. It is sold by AstraZeneca under the trade name Effox. Effox is used to for the the prophylactic treatment of angina pectoris; that is, it is taken in order to prevent or at least reduce the occurrence of angina. Research on Effox as a cervical ripener to reduce time at hospital to birth is supportive. Effox is an active metabolite of isosorbide dinitrate and exerts qualitatively similar effects. Effox reduces the workload of the heart by producing venous and arterial dilation. By reducing the end diastolic pressure and volume, Effox lowers intramural pressure, hence leading to an improvement in the subendocardial blood flow. The net effect when administering Effox is therefore a reduced workload for the heart and an improvement in the oxygen supply/demand balance of the myocardium. The adverse reactions which follow have been reported in studies with Effox: Very common. Headache predominates (up to 30%) necessitating withdrawal of 2 to 3 % of patients, but the incidence reduces rapidly as treatment continues. Common. Tiredness, sleep disturbances (6%) and gastrointestinal disturbances (6%) have been reported during clinical trials with Effox modified release tablets, but at a frequency no greater than for placebo. Hypotension (4 to 5%), poor appetite (2.5%), nausea (1%). Adverse effects associated with the clinical use of the drug are as expected with all nitrate preparations. They occur mainly in the early stages of treatment. Hypotension (4%) with symptoms such as dizziness and nausea (1%) have been reported. These symptoms generally disappear during long-term treatment. Other reactions that have been reported with Effox modified release tablets include tachycardia, vomiting, diarrhoea, vertigo and heartburn

Effox dosage

Effox Dosage

Generic name: Effox 30mg

Dosage form: tablet, extended release

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

The recommended starting dose of Effox Tablets is 30 mg (given as a single 30 mg tablet or as 1/2 of a 60 mg tablet) or 60 mg (given as a single tablet) once daily. After several days, the dosage may be increased to 120 mg (given as a single 120 mg tablet or as two 60 mg tablets) once daily. Rarely, 240 mg may be required. The daily dose of Effox Tablets should be taken in the morning on arising. Effox Extended Release Tablets should not be chewed or crushed and should be swallowed together with a half-glassful of fluid. Do not break the 30 mg tablet.

More about Effox (Effox)

• Side Effects
• During Pregnancy
• Dosage Information
• Drug Images
• Drug Interactions
• Support Group
• En Espanol
• 7 Reviews - Add your own review/rating

Consumer resources

• Effox
• Effox sustained-release tablets
• Effox (Advanced Reading)

• Other brands: Effox, Monoket

Professional resources

• Effox (FDA)

Related treatment guides

• Heart Failure
• Angina
• Angina Pectoris Prophylaxis

Effox interactions

See also:
What other drugs will affect Effox?

Effox has been reported to enhance the sedative activity of barbiturates, alcohol, chlorpromazine, and reserpine.

Peripheral Neuropathy: Medications known to be associated with peripheral neuropathy should be used with caution in patients receiving thalidomide.

Oral Contraceptives:

In 10 healthy women, the pharmacokinetic profiles of norethindrone and ethinyl estradiol following administration of a single dose containing 1.0 mg of norethindrone acetate and 75 µg of ethinyl estradiol were studied. The results were similar with and without coadministration of thalidomide 200 mg/day to steady-state levels.

Important Non-Effox Drug Interactions

Drugs That Interfere with Hormonal Contraceptives: Concomitant use of HIV-protease inhibitors, griseofulvin, modafinil, penicillins, rifampin, rifabutin, phenytoin, carbamazepine, or certain herbal supplements such as St. Johns Wort with hormonal contraceptive agents may reduce the effectiveness of the contraception and up to one month after discontinuation of these concomitant therapies. Therefore, women requiring treatment with one or more of these drugs must use two OTHER effective or highly effective methods of contraception or abstain from heterosexual sexual contact while taking thalidomide.

Effox side effects

See also:
What are the possible side effects of Effox?

The table below shows the frequencies of the adverse events that occurred in >5% of the subjects in three placebo-controlled North American studies in which patients in the active treatment arm received 30 mg, 60 mg, 120 mg, or 240 mg of Effox as Effox Tablets once daily. In parentheses, the same table shows the frequencies with which these adverse events were associated with the discontinuation of treatment. Overall, 8% of the patients who received 30 mg, 60 mg, 120 mg, or 240 mg of Effox in the three placebo-controlled North American studies discontinued treatment because of adverse events. Most of these discontinued because of headache. Dizziness was rarely associated with withdrawal from these studies. Since headache appears to be a dose-related adverse effect and tends to disappear with continued treatment, it is recommended that Effox treatment be initiated at low doses for several days before being increased to desired levels.

FREQUENCY AND ADVERSE EVENTS (DISCONTINUED)*

Three Controlled North American Studies
Dose	Placebo	30 mg	60 mg	120 mg†	240 mg†
* Some individuals discontinued for multiple reasons. † Patients were started on 60 mg and titrated to their final dose.
Patients	96	60	102	65	65
Headache	15% (0%)	38% (5%)	51% (8%)	42% (5%)	57% (8%)
Dizziness	4% (0%)	8% (0%)	11% (1%)	9% (2%)	9% (2%)

In addition, the three North American trials were pooled with 11 controlled trials conducted in Europe. Among the 14 controlled trials, a total of 711 patients were randomized to Effox Tablets. When the pooled data were reviewed, headache and dizziness were the only adverse events that were reported by >5% of patients. Other adverse events, each reported by ≤5% of exposed patients, and in many cases of uncertain relation to drug treatment, were:

Autonomic Nervous System Disorders: Dry mouth, hot flushes.

Body as a Whole: Asthenia, back pain, chest pain, edema, fatigue, fever, flu-like symptoms, malaise, rigors.

Cardiovascular Disorders, General: Cardiac failure, hypertension, hypotension.

Central and Peripheral Nervous System Disorders: Dizziness, headache, hypoesthesia, migraine, neuritis, paresis, paresthesia, ptosis, tremor, vertigo.

Gastrointestinal System Disorders: Abdominal pain, constipation, diarrhea, dyspepsia, flatulence, gastric ulcer, gastritis, glossitis, hemorrhagic gastric ulcer, hemorrhoids, loose stools, melena, nausea, vomiting.

Hearing and Vestibular Disorders: Earache, tinnitus, tympanic membrane perforation.

Heart Rate and Rhythm Disorders: Arrhythmia, arrhythmia atrial, atrial fibrillation, bradycardia, bundle branch block, extrasystole, palpitation, tachycardia, ventricular tachycardia.

Liver and Biliary System Disorders: SGOT increase, SGPT increase.

Metabolic and Nutritional Disorders: Hyperuricemia, hypokalemia.

Musculoskeletal System Disorders: Arthralgia, frozen shoulder, muscle weakness, musculoskeletal pain, myalgia, myositis, tendon disorder, torticollis.

Myo-, Endo-, Pericardial and Valve Disorders: Angina pectoris aggravated, heart murmur, heart sound abnormal, myocardial infarction, Q wave abnormality.

Platelet, Bleeding and Clotting Disorders: Purpura, thrombocytopenia.

Psychiatric Disorders: Anxiety, concentration impaired, confusion, decreased libido, depression, impotence, insomnia, nervousness, paroniria, somnolence.

Red Blood Cell Disorder: Hypochromic anemia.

Reproductive Disorders, Female: Atrophic vaginitis, breast pain.

Resistance Mechanism Disorders: Bacterial infection, moniliasis, viral infection.

Respiratory System Disorders: Bronchitis, bronchospasm, coughing, dyspnea, increased sputum, nasal congestion, pharyngitis, pneumonia, pulmonary infiltration, rales, rhinitis, sinusitis.

Skin and Appendages Disorders: Acne, hair texture abnormal, increased sweating, pruritus, rash, skin nodule.

Urinary System Disorders: Polyuria, renal calculus, urinary tract infection.

Vascular (Extracardiac) Disorders: Flushing, intermittent claudication, leg ulcer, varicose vein.

Vision Disorders: Conjunctivitis, photophobia, vision abnormal.

In addition, the following spontaneous adverse event has been reported during the marketing of Effox: syncope.

Effox contraindications

See also:
What is the most important information I should know about Effox?

Do not use Effox if you are taking sildenafil (Viagra, Revatio). Serious, life-threatening side effects can occur if you take Effox while you are using sildenafil.

You should not use this medication if you are allergic to Effox, isosorbide dinitrate, (Isordil, Dilatrate, Isochron), or nitroglycerin, or if you have early signs of a heart attack (chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling).

Before taking Effox, tell your doctor if you have congestive heart failure, low blood pressure, or kidney disease.

Effox can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use the medication. Do not stop taking Effox. Ask your doctor before using any headache pain medication.

Effox will not treat an angina attack that has already begun.

Use Effox regularly to prevent an angina attack. Get your prescription refilled before you run out of medicine completely.

Do not stop taking Effox suddenly. Stopping suddenly could cause a severe angina attack.

Active ingredient matches for Effox:

Isosorbide Mononitrate in Poland, Russian Federation.

Unit description / dosage (Manufacturer)	Price, USD
Tablet; Oral; Isosorbide Mononitrate 20 mg
List of Effox substitutes (brand and generic names):
Efforeen (China)
Effox 25 Biphasic
Effox 40
Effox 50 Biphasic
Effox Long (Poland)
Capsule, Prolonged Release; Oral; Isosorbide Mononitrate 50 mg
Tablet, Prolonged Release; Oral; Isosorbide Mononitrate 50 mg
Elan (Italy)
Elantan (China, Ecuador, Estonia, Germany, Hong Kong, Ireland, Latvia, Lithuania, Luxembourg, Malaysia, Oman, Peru, Philippines, Singapore, South Africa, Sri Lanka, Thailand, United Kingdom, Venezuela)
Tablet; Oral; Isosorbide Mononitrate 10 mg (Schwarz pharma)
Tablet; Oral; Isosorbide Mononitrate 20 mg (Schwarz pharma)
Tablet; Oral; Isosorbide Mononitrate 40 mg (Schwarz pharma)
Elantan 20 mg x 50's (Schwarz pharma)
Elantan Long 50 mg x 20's (Schwarz pharma)
Elantan LA25 25 mg x 28's (Schwarz pharma)
Elantan LA 25 25 mg x 28's (Schwarz pharma)
Elantan 40 mg x 50's (Schwarz pharma)
Elantan 50 mg x 20's (Schwarz pharma)	$ 11.45
Elantan 20 mg x 50's (Schwarz pharma)	$ 12.36
Elantan 40 mg x 50's (Schwarz pharma)	$ 18.21
Elantan LA (Malaysia)
Capsule, Prolonged Release; Oral; Isosorbide Mononitrate 25 mg
Capsule, Prolonged Release; Oral; Isosorbide Mononitrate 50 mg
Elantan LA25 (United Kingdom)
Elantan LA50 (United Kingdom)
Elantan Long (Ecuador, Estonia)
Capsule, Retard; Oral; Isosorbide Mononitrate
Elantan Retard
Elantan SR (South Korea)
Elantan/Elantan Long/Elantan LA 25 (Malaysia)
Elatan (Philippines)
Elroton (South Korea)
Epicordin (Austria, Germany)
Epicordin, Austria
Esmo (Bangladesh)
Esmo-LA (Bangladesh)
Etimonis (China)
Fei Ke Xin Kang (China)
Fem-Mono (Denmark)
Fem-Mono Retard (Denmark)
Feng Nuo (China)
Fu Shun (China)
Fu Xin Tian (China)
Fumax 20
Fumax 40
G-Dil (Greece)
See 1244 substitutes for Effox

References

1. DailyMed. "ISOSORBIDE MONONITRATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
2. PubChem. "ISOSORBIDE MONONITRATE". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
3. DrugBank. "ISOSORBIDE MONONITRATE". http://www.drugbank.ca/drugs/DB01020 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Effox are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Effox. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

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Information checked by Dr. Sachin Kumar, MD Pharmacology