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isosorbide dinitrate (Rx)Brand and Other Names:Dilatrate-SR, Isordil, more...Isordil Titradose, ISDN

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule/tablet, extended release

  • 40mg

tablet, sublingual

  • 2.5mg
  • 5mg

tablet

  • 5mg
  • 10mg
  • 20mg
  • 30mg
  • 40mg
more...

Angina Pectoris

Immediate release: 5-20 mg PO q8-12hr initially; maintenance: 10-40 mg PO q8-12hr

Extended release: 40 mg PO initially; maintenance: 40-80 mg PO q8-12hr

SL (prophylaxis): 2.5-5 mg 15 minutes before performing activities likely to cause angina

SL (treatment): 2.5-5 mg; may be repeated q5-10min; not to exceed 3 doses in 15-30 minutes

Safety and efficacy not established

Angina Pectoris

Start with lowest recommended dose

Start with lowest recommended adult dose

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Interactions

Interaction Checker

isosorbide dinitrate and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Cardiovascular: Rebound hypertension (uncommon), syncope, unstable angina flushing, hypotension/orthostatic hypotension, lightheadedness, palpitations, tachyarrhythmia

            Central nervous system (CNS): Dizziness, headache, restlessness, weakness

            Gastrointestinal (GI): Nausea

            Hematologic: Methemoglobinemia (infrequent)

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            Warnings

            Contraindications

            Hypersensitivity

            Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life

            Severe anemia, shock, markedly low blood pressure (BP)

            Concomitant administration with guanylate stimulator riociguat

            Cautions

            Allergies to nitrates, head trauma/cerebral hemorrhage (potential contraindication), hypertrophic cardiomyopathy, increased intraocular pressure, postural hypotension, acute myocardial infarction (MI), congestive heart failure, hyperthyroidism

            Inability to relieve chest pain after 3 doses may signal acute MI necessitating emergency management

            Tolerance to extended-release formulation may develop, rendering formulation ineffective after a few weeks

            Do not change brands unintentionally; formulations are not all bioequivalent

            Severe hypotension, particularly with upright posture, may occur with even small doses; use with caution in patients who may be volume depleted or who are already hypotensive; hypotension induced by isosorbide dinitrate may be accompanied by paradoxical bradycardia and increased angina pectoris

            Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy

            Treat drug-induced headache with aspirin or acetaminophen

            Provide nitrate-free interval (10-12 hours or overnight) to prevent development of tolerance

            Use supportive treatment in overdose

            Avoid use of extended release formulation in acute MI or acute heart failure; adverse events are not easily reversible if they develop

            Avoid use in patients with hypertrophic cardiomyopathy with outflow tract obstruction; nitrates may reduce preload, which may cause exacerbation of obstruction and cause hypotension or syncope and/or worsening of heart failure

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown whether drug is distributed into breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Vasodilating agent (nitric oxide donor); relaxes smooth muscle via dose-dependent dilation of arterial and venous beds to reduce both preload and afterload, as well as myocardial oxygen demand; also improves coronary collateral circulation, lowering blood pressure, increasing heart rate, and causing occasional paradoxical bradycardia

            Absorption

            ~100% absorbed from GI tract or oral mucosa

            Bioavailability: Immediate release, 40-50%

            Duration: 1-2 hr

            Distribution

            Vd: 2-4 L/kg

            Metabolism

            Extensively metabolized in liver to conjugated metabolites

            Elimination

            Half-life: 1 hr

            Excretion: Urine (80-100%), feces

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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