II. General
- Need 10-12 hours Nitroglycerin free interval per day
- Not proven to reduce Incidence of future events
III. Indications
- Chronic Angina Pectoris prophylaxis
- Not indicated for acute Myocardial Ischemia
-
Congestive Heart Failure (not FDA approved)
- Combine with Hydralazine
IV. Precautions
- Nitrate free period of 10-14 hours per day prevents the development of nitrate tolerance
- Swallow whole and do not crush or chew
V. Dosing
- Isosorbide Dinitrate (Isordil)
- Regular
- Start 5 to 20 mg orally three times daily (7am, 12 noon, 5pm)
- Maximum: 40 mg orally three times daily
- Sustained Release
- Start 40 mg orally twice daily (8 am, 3 pm)
- Maximum: 80 mg orally twice daily
- Regular
- Isosorbide Mononitrate (Imdur)
- Regular
- Start 20 mg orally twice daily (8 am, 3 pm)
- Extended Release
- Start 30 mg orally daily
- May advance to 60 mg orally daily
- Maximum: 240 mg/day (maximum dose is rarely indicated)
- Regular
VI. Pharmacokinetics
- Isosorbide Dinitrate (Isordil) Regular Sublingual
- Onset: 5 minutes
- Duration: 1 to 4 hours
- Isosorbide Dinitrate (Isordil) Regular Oral
- Onset: 30 minutes
- Duration: 4 to 6 hours
- Isosorbide Dinitrate (Isordil) Sustained Release Oral
- Onset: 30 minutes
- Duration: 8 hours
VII. Adverse Effects
- See Nitroglycerin
VIII. Mechanism
- See Nitroglycerin
IX. Safety
- Pregnancy Category C
- Unknown safety in Lactation
X. Resources
- Isosorbide Mononitrate (DailyMed)
- Isosorbide Dinitrate (DailyMed)
XI. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
Images: Related links to external sites (from Bing)
Related Studies
| 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 |
Ontology: Isosorbide (C0022251)
| Definition (CHV) | a drug used to prevent or treat chest pain (angina). |
| Definition (NCI) | An organic nitrate with vasodilator activity. Isosorbide relaxes vascular smooth muscle by formation of the free radical nitric oxide (NO), which is identical to the endothelium-derived relaxing factor (EDRF). NO activates guanylyl cyclase, thereby increasing the synthesis of cGMP within smooth muscle. Elevated cGMP levels in smooth muscle activate cGMP-dependent kinase activity that leads to release of sequestered Ca2+. In turn, free Ca+ triggers dephosphorylation of light chain myosin and relaxation of peripheral arteries and veins. In addition isosorbide relaxes coronary arteries, thereby increasing the blood circulation through the ischemic area. |
| Definition (MSH) | 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma. |
| Concepts | Pharmacologic Substance (T121) , Carbohydrate (T118) |
| MSH | D007547 |
| SnomedCT | 108478001, 386853004 |
| LNC | LP171613-5 |
| English | Isosorbide, D-Glucitol, 1,4:3,6-dianhydro-, isosorbide, Isosorbide [Chemical/Ingredient], ISOSORBIDE, Isosorbide (product), Isosorbide (substance) |
| Swedish | Isosorbid |
| Czech | isosorbid |
| Finnish | Isosorbidi |
| Russian | IZOSORBID, ИЗОСОРБИД |
| Japanese | イソソルビド |
| Croatian | IZOSORBID |
| Spanish | Isosorbida, isosorbida (producto), isosorbida (sustancia), isosorbida |
| Polish | Izosorbid |
| Portuguese | Isossorbido, Isossorbida |
| French | Isosorbide |
| German | Isosorbid |
| Italian | Isosorbide |
Ontology: Isosorbide Dinitrate (C0022252)
| Definition (NCI) | The dinitrate salt form of isosorbide, an organic nitrate with vasodilator activity. Isosorbide dinitrate relaxes vascular smooth muscle by formation of the free radical nitric oxide (NO), which is identical to the endothelium-derived relaxing factor (EDRF). NO activates guanylyl cyclase, thereby increasing the synthesis of cGMP within smooth muscle, resulting in dephosphorylation of light chain myosin and relaxation of peripheral arteries and veins. In addition, isosorbide dinitrate relaxes coronary arteries, thereby increasing the blood circulation through the ischemic area. (NCI05) |
| Definition (MSH) | A vasodilator used in the treatment of ANGINA PECTORIS. Its actions are similar to NITROGLYCERIN but with a slower onset of action. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D007548 |
| SnomedCT | 387332007, 5924003 |
| English | Dinitrate, Isosorbide, ISDN, Isosorbide Dinitrate, D-Glucitol, 1,4:3,6-dianhydro-, dinitrate, isosorbide dinitrate, isosorbide dinitrate (medication), vasodilators coronary isosorbide dinitrate, ISOSORBIDE DINITRATE, Isosorbide Dinitrate [Chemical/Ingredient], isd, isdn, Isosorbide dinitrate, ISD, ISDN - isosorbide dinitrate, sorbide nitrate, Isosorbide dinitrate (product), Isosorbide dinitrate (substance) |
| Swedish | Isosorbiddinitrat |
| Czech | isosorbiddinitrát |
| Finnish | Isosorbididinitraatti |
| French | Dinitrate d'isosorbide, Dinitrate isosorbide |
| Russian | IZOSORBIDA DINITRAT, NITROSORBID, ИЗОСОРБИДА ДИНИТРАТ, НИТРОСОРБИД |
| Japanese | 二硝酸イソソルビド, 硝酸イソソルビド, イソソルビドジニトラート, イソソルビド二硝酸 |
| Croatian | IZOSORBID DINITRAT |
| Polish | Diazotan izosorbidu, Dwuazotan izosorbidu |
| Spanish | dinitrato de isosorbida (producto), dinitrato de isosorbida (sustancia), dinitrato de isosorbida, Dinitrato de Isosorbide |
| German | Isosorbiddinitrat |
| Italian | Dinitrato di isosorbide |
| Portuguese | Dinitrato de Isossorbida |
Ontology: Isosorbide Mononitrate (C0064079)
| Definition (NCI) | The mononitrate salt form of isosorbide, an organic nitrate with vasodilator activity. Isosorbide mononitrate relaxes vascular smooth muscle by formation of the free radical nitric oxide (NO), which is identical to the endothelium-derived relaxing factor (EDRF). NO activates guanylyl cyclase, thereby increasing the synthesis of cGMP within smooth muscle, resulting in dephosphorylation of light chain myosin and relaxation of peripheral arteries and veins. In addition, isosorbide mononitrate relaxes coronary arteries, thereby increasing the blood circulation through the ischemic area. (NCI05) |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C030397 |
| SnomedCT | 108484003, 386854005 |
| English | 5-ISMN, isosorbide-5-mononitrate, isosorbide-5-nitrate, 1,4:3,6-Dianhydro-D-glucitol 5-nitrate, isosorbide mononitrate, monocinque, isosorbide mononitrate (medication), Isosorbide Mononitrate, ISOSORBIDE MONONITRATE, isosorbide-5-mononitrate [Chemical/Ingredient], mononitrate isosorbide, isosorbide 5 mononitrate, ISMN - isosorbide mononitrate, ISMO - isosorbide mononitrate, Isosorbide mononitrate, Isosorbide mononitrate product, Isosorbide mononitrate (product), Isosorbide mononitrate (substance) |
| Spanish | mononitrato de isosorbida (producto), mononitrato de isosorbida (sustancia), mononitrato de isosorbida |
