Imdex should be used with caution in patients with severe hepatic or renal impairment, hypothyroidism, malnutrition, hypothermia or with a recent history of myocardial infarction.
The use of Imdex during pregnancy and breast-feeding is not recommended due to lack of information.
Nitrate tolerance: Development of tolerance may occur with all forms of nitrate therapy particularly with the long acting nitrate preparations that maintain continuously high plasma nitrate concentration.
e.g. by taking more than 120 mg/day of Imdex and/or twice daily dosage, the risk of development of tolerance may occur. It is therefore very important that Imdex should be taken once a day in order to achieve a period of low nitrate concentration at night, reducing the risk of development of tolerance.
Withdrawal of nitrates should be gradual to avoid precipitation of acute angina.
Use in Elderly: Elderly patients may be more sensitive to the hypotensive effects of nitrates. In addition, they are more likely to have age-related renal function impairment, which may require caution in patients receiving nitrates.