Isosorbide Nitrates(eye soe sor’ bide)
Isosorbide Dinitrate
Apo-ISDN (CAN), Dilatrate SRDNC, IsochronDNC, Isordil Titradose
Isosorbide Mononitrate
ImdurDNC, ISMO, Monoket
PREGNANCY CATEGORY C
PREGNANCY CATEGORY B
(IMDUR, MONOKET)
Drug Classes
Antianginal
Nitrate
Vasodilator
Therapeutic Actions
Relaxes vascular smooth muscle with a resultant decrease in venous return and decrease in arterial BP, which reduces left ventricular workload and decreases myocardial oxygen consumption.
Indications
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Dinitrate: Treatment and prevention of angina pectoris
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Mononitrate: Prevention of angina pectoris; treatment of angina pectoris (Monoket)
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Unlabeled uses (dinitrate): Used with hydralazine in black patients with advanced heart failure; acute angle-closure glaucoma in emergent situations; achalasia
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Unlabeled use (mononitrate): Used with nadolol to prevent recurrent variceal bleeding
Contraindications and Cautions
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Contraindicated with allergy to nitrates, severe anemia, head trauma, cerebral hemorrhage, hypertrophic cardiomyopathy, narrow-angle glaucoma, orthostatic hypotension.
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Use cautiously with pregnancy, lactation, acute MI, heart failure.
Available Forms
Dinitrate: Tablets—5, 10, 20, 30, 40 mg; ER tabletsDNC—40 mg; SR capsulesDNC—40 mg; SL tablets—2.5, 5 mg
Mononitrate: Tablets—10, 20 mg; ER tabletsDNC—30, 60, 120 mg
Dosages
Adults
To avoid tolerance to drug, take short-acting products bid or tid with last dose no later than 7 PM and ER or SR products once daily or bid at 8 AM and 2 PM. This creates a nitrate-free period.
Isosorbide dinitrate
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Angina pectoris: Starting dose, 2.5–5 mg sublingual or 5- to 20-mg oral tablets. For maintenance, 10–40 mg every 6 hr or tid oral tablets or capsules; SR or ER, initially 40 mg, then 40–80 mg PO every 8–12 hr.
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Acute prophylaxis: Initial dosage, 2.5–5 mg sublingually every 2–3 hr. Give 15 min before activity that may cause angina.
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