Isosorbide Dinitrate (isosorbide dinitrate)
OTHER BRAND NAMES
Prevention of angina pectoris due to coronary artery disease (CAD). (Tab, SL) Treatment of angina pectoris due to CAD.
Due to Coronary Artery Disease:
Initial: 5-20mg bid-tid
Maint: 10-40mg bid-tid
Allow a dose-free interval of ≥14 hrs
Tab, Extended Release:
Refer to PI for dosing based on clinical trials
Prevention: 1 tab (2.5mg-5mg) 15 min before activity
Treatment: Use to abort acute angina episode recommended only in patients who fail to respond to SL nitroglycerin
Must provide a daily dose-free interval; 1 of the daily dose-free intervals must be somewhat >14 hrs
Start at lower end of dosing range
Tab, Extended Release (ER): 40mg*; Tab, SL: 2.5mg, 5mg; Tab: 10mg*, 20mg*, 30mg*, (Isordil Titradose) 5mg*, 40mg* *scored
Concomitant use w/ certain drugs for erectile dysfunction (eg, sildenafil, tadalafil, vardenafil) and soluble guanylate cyclase stimulator riociguat.
Severe hypotension, particularly w/ upright posture, may occur. Perform careful clinical or hemodynamic monitoring if used in patients w/ acute MI or CHF to avoid the hazards of hypotension and tachycardia. Hypotension may be accompanied by paradoxical bradycardia and increased angina pectoris. May aggravate angina caused by hypertrophic cardiomyopathy. Caution w/ volume depletion and hypotension. May develop tolerance. Chest pain, acute MI, and sudden death reported during temporary withdrawal in patients w/ long term exposure to therapy. (Tab, SL) Not the 1st drug of choice for abortion of acute anginal episode.
Headache, lightheadedness, hypotension, syncope, crescendo angina, rebound HTN.
See Contraindications. Additive vasodilation w/ other vasodilators (eg, alcohol).
PREGNANCY AND LACTATION
Category C, caution in nursing.
MECHANISM OF ACTION
Nitrate vasodilator; relaxes vascular smooth muscle and dilates peripheral arteries and veins; venous dilatation reduces left ventricular end diastolic pressure and pulmonary capillary wedge pressure (preload); arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload); dilates the coronary artery.
Absorption: (Tab) Nearly complete; bioavailability (10-90%); Tmax=1 hr. (Tab, SL) Bioavailability (40-50%); Tmax=10-15 min. Distribution: Vd=2-4L/kg. Metabolism: Liver (extensive 1st-pass) (tab); 2-mononitrate, 5-mononitrate (active metabolites). Elimination: T1/2=1 hr, 5 hrs (5-mononitrate), 2 hrs (2-mononitrate).
Assess for drug hypersensitivity, hypotension, acute MI, CHF, volume depletion, hypertrophic cardiomyopathy, alcohol intake, pregnancy/nursing status, and possible drug interactions.
Monitor for paradoxical bradycardia, increased angina pectoris, hypotension, hemodynamic rebound, decreased exercise tolerance, chest pain, acute MI, and other adverse reactions. In patients w/ MI or CHF, perform careful clinical or hemodynamic monitoring.
Counsel to carefully follow prescribed dosing regimen. Inform that headaches sometimes accompany therapy and are markers of drug activity; instruct not to alter schedule of therapy since loss of headache may be associated w/ simultaneous loss of antianginal efficacy. Inform that lightheadedness on standing may occur, which may be more frequent w/ alcohol consumption.
(Tab) 25°C (77°F); (Isordil Titradose) excursions permitted to 15-30°C (59-86°F). Protect from light. (Tab, SL/Tab, ER) 20-25°C (68-77°F). (Tab, SL) Protect from light and moisture.
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