I have Ischemic Heart Disease, and a junior doctor in my local surgery has changed one of my tablets .?

I have been on "elanton xl" for 9 years, last month I was given "isodur xl",,, this month I have been given "isotard xl"
I am not as painfree as I usually am..Is the tablets to blame???

The general advice I would give is to avoid long acting nitrates. It might be better to take a basic isosorbide mononitrate, 'staggered' twice daily. i.e. 9am and 4pm. This gives a nitrate free period and helps avoid nitrate tolerance, which makes the drug less effective. Most prescribing advisers suggest using this method. The doctors 'Bible' of prescribing( The British National Formulary) also suggests this. It needs a password to access so I will 'borrow' the relevant paragraph, with apologies.

Tolerance

Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 8 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for several consecutive hours in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses can be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance. Source(s): GP for more years than I care to remember

I think you should speak to whomever supervises him. if you are at all unsure, remember its your life not his.
isodur and isotard are the same drug. cannot find a drug with the name "elanton."

You should explain to the doctor that you have increased pain now, and would like to use the drug you had been using, to see it the problem is related to the change in drugs.

But my feeling is that this "elanton" is just another brand of isosorbide mononitrate, same as isodur and isotard. Or, it could be some other form of nitrate, which indeed could work better for you.