ISOSORBIDE DINITRATE

Anti-angina nitrate vasodilator medicine

Dosage Forms

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Sublingual tablet

5 mg

Uses

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  • Prophylaxis of angina
  • Treatment of angina
  • Adjunctive therapy in left ventricular failure

Dose and Duration

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Prophylaxis and treatment of angina
  • Adult: 30–120 mg daily in 1–2 divided doses according to individual need
Left ventricular failure
  • Adult: 40–160 mg daily in divided doses up to a maximum of 240 mg dependent on individual need

Contraindications

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  • Hypersensitivity to nitrates
  • Hypotension, hypovolemia
  • Hypertrophic obstructive cardiomyopathy
  • Aortic stenosis
  • Cardiac tamponade
  • Constrictive pericarditis
  • Mitral stenosis
  • Marked anaemia
  • Head trauma
  • Cerebral haemorrhage
  • Angle-closure glaucoma

Side Effects

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  • Headache (at beginning of treatment)
  • Drowsiness, weakness
  • Cutaneous vasodilation, flushing, orthostatic hypotension, decrease in blood pressure, reflex tachycardia
  • Peripheral oedema in patients with left ventricular failure

Interactions

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  • Sildenafil (hypotensive effect significantly enhanced)
  • Tadalafil (hypotensive effect significantly enhanced)

Pregnancy

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  • Do not use

Breast-feeding

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  • Do not use

⚠️ Caution

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  • Long-term use may lead to development of tolerance to its antianginal effect. Ensure a nitrate free interval each day (give second daily dose after 8 hours not 12 hours)
  • Increase dose gradually to minimise the possibility of nitrate headache and/or tolerance
  • Cross-tolerance to other nitrates may occur
  • May cause haemolysis in patients with G6PD deficiency
  • May precipitate intra-cardiac conduction abnormalities when used in patients with seriously damaged myocardia
  • Use with caution in severe hepatic or renal impairment, hypothyroidism, malnutrition or hypothermia