Adult: 20-120 mg daily in divided doses. Gradually increase according to patient's response. Max: 240 mg daily.
Sublingual Acute angina
Adult: 2.5-10 mg placed under the tongue.
Sublingual Heart failure
Adult: 5-10 mg every 2 hours as needed.
Should be taken on an empty stomach. Take 30 min before meals.
Avoid use of PVC containers as significant losses of the active ingredient by adsorption may occur.
Aortic or mitral stenosis, marked anaemia, cardiac tamponade, hypertrophic cardiomyopathy, hypotension, hypovolaemia, raised intracranial pressure. Concomitant use of a phosphodiesterase 5 (PDE5) inhibitors and riociguat.
Patients w/ susceptibility to angle-closure glaucoma, hypothermia, hypothyroidism, hypoxaemia, malnutrition, MI, toxic pulmonary oedema, constrictive pericarditis, ventilation and perfusion abnormalities. Severe renal and hepatic impairment. Pregnancy and lactation.
This drug may cause dizziness on standing, sit or lie down before use and get up gradually to minimise this effect.
Monitor BP and heart rate closely during IV admin.
Symptoms: Increased intracranial pressure (manifested by throbbing headache, confusion, and moderate fever), vertigo, palpitations, visual disturbances, nausea, vomiting, syncope, dyspnoea, diaphoresis, heart block, bradycardia, paralysis, coma, seizures, methaemoglobinaemia. Management: Passive elevation of the patient’s legs may be sufficient but IV infusion of normal saline or similar fluid may also be necessary. Methaemoglobinaemia may be treated w/ IV methylene blue 1-2 mg/kg.
Reduced effect w/ disopyramide (sublingual). Additive hypotensive effects w/ antihypertensive drugs or phenothiazines. Potentially Fatal: Risk of severe hypotension, myocardial ischaemia, or syncope w/ PDE5 inhibitors (e.g. sildenafil). Increased risk of hypotension w/ riociguat.
Enhanced vasodilatory effect w/ alcohol.
Description: Isosorbide dinitrate, a nitro vasodilator, is a source of nitric oxide which stimulates cyclic guanosine 3’,5’monophosphate (cGMP), thereby relaxing the vascular smooth muscles. It decreases left ventricular pressure (preload) and arterial resistance (afterload). Onset: 2-5 min (sublingual); approx 1 hr (oral). Duration: 1-2 hr (sublingual); ≤8 hr (oral). Pharmacokinetics: Absorption: Readily absorbed from the oral mucosa (sublingual) and from the GI tract (oral). Bioavailability: Highly variable (10-90%). Distribution: Widely distributed. Volume of distribution: 2-4 L/kg. Plasma protein binding: Approx 28%. Metabolism: Undergoes extensive hepatic first-pass metabolism; converted to active isosorbide 2-mononitrate and 5-mononitrate. Also metabolised via denitration and glucuronidation. Excretion: Via urine (80-100%, as metabolites). Elimination half-life: Approx 1 hr (isosorbide dinitrate); 5 hr (isosorbide 5-mononitrate); 2 hr (isosorbide 2-mononitrate).
C01DA08 - isosorbide dinitrate ; Belongs to the class of organic nitrate vasodilators. Used in the treatment of cardiac disease.
Anon. Isosorbide Dinitrate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 06/07/2017.Anon. Isosorbide Dinitrate/Mononitrate. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 06/07/2017.Buckingham R (ed). Isosorbide Dinitrate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/07/2017.Isosorbide Dinitrate Tablets (Carilion Materials Management). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 06/07/2017.Joint Formulary Committee. Isosorbide Dinitrate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 06/07/2017.