Long Acting Nitroglycerin

Aka: Long Acting Nitroglycerin, Long Acting Nitrates, Isosorbide, Isosorbide Mononitrate, Isosorbide Dinitrate, Imdur

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II. General

  1. Need 10-12 hours Nitroglycerin free interval per day
  2. Not proven to reduce Incidence of future events

III. Indications

  1. Chronic Angina Pectoris prophylaxis
    1. Not indicated for acute Myocardial Ischemia
  2. Congestive Heart Failure (not FDA approved)
    1. Combine with Hydralazine

IV. Precautions

  1. Nitrate free period of 10-14 hours per day prevents the development of nitrate tolerance
  2. Swallow whole and do not crush or chew

V. Dosing

  1. Isosorbide Dinitrate (Isordil)
    1. Regular
      1. Start 5 to 20 mg orally three times daily (7am, 12 noon, 5pm)
      2. Maximum: 40 mg orally three times daily
    2. Sustained Release
      1. Start 40 mg orally twice daily (8 am, 3 pm)
      2. Maximum: 80 mg orally twice daily
  2. Isosorbide Mononitrate (Imdur)
    1. Regular
      1. Start 20 mg orally twice daily (8 am, 3 pm)
    2. Extended Release
      1. Start 30 mg orally daily
      2. May advance to 60 mg orally daily
      3. Maximum: 240 mg/day (maximum dose is rarely indicated)

VI. Pharmacokinetics

  1. Isosorbide Dinitrate (Isordil) Regular Sublingual
    1. Onset: 5 minutes
    2. Duration: 1 to 4 hours
  2. Isosorbide Dinitrate (Isordil) Regular Oral
    1. Onset: 30 minutes
    2. Duration: 4 to 6 hours
  3. Isosorbide Dinitrate (Isordil) Sustained Release Oral
    1. Onset: 30 minutes
    2. Duration: 8 hours

VII. Adverse Effects

  1. See Nitroglycerin

VIII. Mechanism

  1. See Nitroglycerin

IX. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

X. Resources

  1. Isosorbide Mononitrate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ae8f74f0-e600-4452-8557-958b603e2709
  2. Isosorbide Dinitrate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=5c94ecc0-fcaa-4af3-82c2-ff124f2df3e1

XI. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

isosorbide (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ISOSORBIDE DINITRATE 10 MG TAB Generic $0.32 each
ISOSORBIDE DINITRATE 20 MG TAB Generic $0.30 each
ISOSORBIDE DINITRATE 30 MG TAB Generic $0.44 each
ISOSORBIDE DINITRATE 5 MG TAB Generic $0.27 each
ISOSORBIDE MONONIT 10 MG TAB Generic $0.21 each
ISOSORBIDE MONONIT 20 MG TAB Generic $0.17 each
ISOSORBIDE MONONIT ER 120 MG Generic $0.19 each
ISOSORBIDE MONONIT ER 30 MG TB Generic $0.08 each
ISOSORBIDE MONONIT ER 60 MG TB Generic $0.11 each
ISOSORBIDE-HYDRALAZINE 20-37.5 MG TABLET Generic $1.58 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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