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Administration
Should be taken on an empty stomach. Take 30 min before meals.
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Contraindications
Acute circulatory failure (e.g. shock, vascular collapse), hypertrophic obstructive cardiomyopathy; acute MI with low filling pressures, severe hypotension, low cardiac filling pressures, cardiac tamponade, constrictive pericarditis, aortic or mitral valve stenosis, diseases associated with raised intracranial pressure (e.g. following a head trauma, cerebral haemorrhage), marked anaemia, hypovolaemia, cor pulmonale. Concomitant use with phosphodiesterase 5 (PDE5) inhibitors (e.g. sildenafil, vardenafil, tadalafil) and riociguat.
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Special Precautions
Patient with closed-angle glaucoma, malnutrition, hypothyroidism, hypothermia, hypoxaemia, ventilation or perfusion imbalance due to lung disease or ischaemic heart failure, orthostatic syndrome. Avoid abrupt withdrawal. Severe renal and hepatic impairment. Elderly. Pregnancy and lactation. Monitoring Parameters Monitor blood pressure and heart rate. Evaluate closely for volume depletion, hypotension, and right ventricular infarction.
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Adverse Reactions
Significant: Orthostatic or severe hypotension, syncope, tolerance and cross-tolerance to other nitrates; may precipitate haemolysis (in patients with G6PD deficiency); increased intracranial pressure; headache (during initial treatment).
Cardiac disorders: Palpitations, tachycardia, aggravated angina pectoris.
Gastrointestinal disorders: Rarely, nausea, vomiting.
General disorders and administration site conditions: Peripheral oedema (oral), asthenia.
Nervous system disorders: Dizziness, somnolence, cerebral ischaemia.
Skin and subcutaneous tissue disorders: Rarely, allergic skin reactions (e.g. rash).
Vascular disorders: Cutaneous vasodilation (including flushing), circulatory collapse (occasionally accompanied by syncope and bradyarrhythmia).
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Drug Interactions
May act as a physiological antagonist to norepinephrine, acetylcholine, histamine, and other agents. May potentiate hypotensive effects with antihypertensive agents (e.g. Ca channel blockers, β-blockers, angiotensin II receptor blockers). May cause orthostatic hypotension with phenothiazines, MAOIs, and TCAs. Concomitant use in patients already receiving ACE inhibitors may cause symptoms of circulatory collapse.
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CIMS Class
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ATC Classification
C01DA08 - isosorbide dinitrate ; Belongs to the class of organic nitrate vasodilators. Used in the treatment of cardiac disease.
C05AE02 - isosorbide dinitrate ; Belongs to the class of muscle relaxants. Used in the topical treatment for the treatment of hemorrhoids and anal fissures. |
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