What is Iso?
Preventing symptoms of angina (chest pain) caused by heart disease. Iso extended-release capsules is used alone or with other medicines. Iso extended-release capsules is NOT intended for the immediate relief of acute attacks of angina. It may also be used for other conditions as determined by your doctor.
Iso extended-release capsules is a nitrate. It works by relaxing the blood vessels in the body, allowing them to widen. This lets more blood flow through the blood vessels, which reduces the work the heart has to do to pump blood. This reduces the oxygen needs of the heart and makes chest pain go away.
Iso indications
Angina Pectoris:Oral Tablet:
Prophylaxis of ischemic heart pain associated with coronary insufficiency. Iso may reduce the frequency, duration and severity of anginal attacks. Exercise tolerance may be improved and the need for nitroglycerin may be reduced. The oral tablets are not indicated for the treatment of an anginal attack.
Sublingual Tablet: Treatment of angina pectoris and prophylaxis in situations likely to provoke an anginal attack ie, physical or emotional stress.
Congestive Heart Failure: Acute and chronic congestive heart failure (including that associated with myocardial infarction). Based on current knowledge, Iso should be considered only as an adjunct to the more conventional modes of therapy (cardiac glycosides and diuretics); however, in refractory cases, it may be used alone or concomitantly with other vasodilators. Iso is particularly effective in patients with increased left ventricular end diastolic pressure (LVEDP), "backward failure" and normal or approximately normal cardiac output in whom pulmonary congestion or edema is the primary problem. Iso is especially recommended when coronary artery disease is the cause of congestive heart failure, in which case its antianginal effect is of additional value.
How should I use Iso?
Use Iso extended-release capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Take Iso extended-release capsules by mouth on an empty stomach with a full glass of water (8 oz [240 mL]).
- Swallow Iso extended-release capsules whole. Do not break, crush, or chew before swallowing.
- If you miss a dose of Iso extended-release capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Iso extended-release capsules.
Uses of Iso in details
Use: Labeled Indications
Angina pectoris, prevention: Prevention of angina pectoris due to coronary artery disease.
Note: Due to slower onset of action, Iso is not the drug of choice to abort an acute anginal episode.
Off Label Uses
Achalasia
Based on the American College of Gastroenterology (ACG) guidelines on the diagnosis and management of achalasia, Iso may be considered for patients with achalasia who cannot use or refuse more definitive therapies (pneumatic dilation or surgical myotomy) and patients who have failed botulinum toxin injections.
Heart failure with reduced ejection fraction
Data from a randomized, double-blind trial comparing enalapril and hydralazine plus Iso in patients with chronic heart failure support the use of Iso (in combination with hydralazine) in patients with intolerance to ACE inhibitor therapy.
Iso description
Each tablet of Iso 5 mg contains 5 mg of Iso.
Each tablet of Iso 10 mg contains 10 mg of Iso.
Each sustained-release tablet of Iso 20 mg contains 20 mg of Iso.
Each sustained-release tablet of Iso 40 mg contains 40 mg of Iso.
Iso dosage
As noted under "CLINICAL PHARMACOLOGY," multiple-dose studies with Iso and other nitrates have shown that maintenance of continuous 24-hour plasma levels results in refractory tolerance. Every dosing regimen for Iso tablets must provide a daily dose-free interval to minimize the development of this tolerance. With immediate-release Iso, it appears that one daily dose-free interval must be at least 14 hours long.
As also noted under "CLINICAL PHARMACOLOGY," the effects of the second and later doses have been smaller and shorter-lasting than the effects of the first.
Large controlled studies with other nitrates suggest that no dosing regimen with Iso tablets should be expected to provide more than about 12 hours of continuous anti-anginal efficacy per day.
As with all titratable drugs, it is important to administer the minimum dose which produces the desired clinical effect. The usual starting dose of Iso is 5 mg to 20 mg, two or three times daily. For maintenance therapy, 10 mg to 40 mg, two or three times daily is recommended. Some patients may require higher doses. A daily dose-free interval of at least 14 hours is advisable to minimize tolerance. The optimal interval will vary with the individual patient, dose and regimen.
Iso interactions
See also:
What other drugs will affect Iso?
Blood Pressure Lowering Agents: The concomitant use of drugs with blood pressure lowering properties, e.g. vasodilators, beta-blockers, calcium channel antagonists, ACE inhibitors, neuroleptics or tricyclic antidepressants and alcohol may potentiate the antihypertensive effect of Iso.
Phosphodiesterase Inhibitors: A blood pressure lowering effect of Iso will be increased, if used together with phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, vardenafil). This might lead to life-threatening cardiovascular complications. Patients who are on Iso therapy therefore must not use phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, vardenafil).
Patients who have recently taken phosphodiesterase inhibitors (e.g. sildenafil, vardenafil, tadalafil) therefore must not receive acute Iso therapy.
Dihydroergotamine: Iso used in combination with dihydroergotamine may lead to higher blood concentration of dihydroergotamine and thus increase the effect of this medicinal product.
Sapropterine: Sapropterine contains the API Tetrahydrobiopterine (BH4). BH4 is a cofactor for nitric oxide synthetase. Caution is recommended during concomitant use of sapropterine-containing medicine with all agents that cause vasodilation by affecting nitric oxide (NO) metabolism or action, including classical NO donors [e.g. glyceryl trinitrate (GTN), Iso (ISDN), Iso mononitrate and others].
Iso side effects
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What are the possible side effects of Iso?
Adverse reactions to Iso are generally dose-related, and almost all of these reactions are the result of Iso's activity as a vasodilator. Headache, which may be severe, is the most commonly reported side effect. Headache may be recurrent with each daily dose, especially at higher doses. Transient episodes of lightheadedness, occasionally related to blood pressure changes, may also occur. Hypotension occurs infrequently, but in some patients it may be severe enough to warrant discontinuation of therapy. Syncope, crescendo angina, and rebound hypertension have been reported but are uncommon.
Extremely rarely, ordinary doses of organic nitrates have caused methemoglobinemia in normal-seeming patients. Methemoglobinemia is so infrequent at these doses that further discussion of its diagnosis and treatment is deferred.
Data are not available to allow estimation of the frequency of adverse reactions during treatment with Iso tablets.
To report SUSPECTED ADVERSE REACTIONS contact AvKARE, Inc. at 1-855-361-3993; email drugsafety@avkare.com; or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Iso contraindications
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What is the most important information I should know about Iso?
Do not use Iso if you are taking sildenafil (Viagra). Serious, life-threatening side effects can occur if you take Iso while you are using sildenafil.
You should not use this medication if you are allergic to Iso, Iso mononitrate (Imdur, ISMO, Monoket), or nitroglycerin, or if you have early signs of a heart attack (chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling).
Before taking Iso, tell your doctor if you have congestive heart failure, low blood pressure, or kidney disease.
Iso can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use the medication. Do not stop taking Iso. Ask your doctor before using any headache pain medication.
Only the sublingual tablet should be used to treat an angina attack that has already begun.
Iso regular and extended-release tablets are used to prevent angina attacks but will not treat an angina attack.
It is important to keep taking this medicine as directed to prevent an angina attack. Get your prescription refilled before you run out of medicine completely.
Do not stop taking Iso suddenly. Stopping suddenly could cause a severe angina attack.
Active ingredient matches for Iso:
Isosorbide Dinitrate in Spain.
| Unit description / dosage (Manufacturer) | Price, USD |
| ISO 10mg TAB / 10 | $ 0.13 |
| ISO 20mg TAB / 10 | $ 0.23 |
| Iso 10 mg Tablet | $ 0.01 |
| ISO 10 mg Zee Labs Tablet | $ 0.02 |
| ISO 100 mg Tablet | $ 0.01 |
| Iso 20 mg Tablet | $ 0.02 |
| ISO 300 mg Tablet | $ 0.02 |
| ISO 20MG TABLET 1 strip / 10 tablets each (S P Pharma) | $ 0.74 |
| ISO 10mg TAB / 10 | $ 0.13 |
| ISO 20mg TAB / 10 | $ 0.23 |
| Iso 10mg Tablet (Zee Laboratories) | $ 0.02 |
| Iso 20mg Tablet (S P Pharma) | $ 0.07 |
List of Iso substitutes (brand and generic names): | |
| ISDN-ratiopharm (Estonia, Germany, Latvia, Lithuania, Luxembourg) | |
| Iso Lacer (Spain) | |
| Iso Mack (Bahrain, Cyprus, Egypt, Jordan, Kuwait, Lebanon, Qatar, Saudi Arabia, United Arab Emirates) | |
| Spray; Subbucal; Isosorbide Dinitrate (Boots healthcare) | |
| Iso Mack Buccal | |
| Spray; Subbucal; Isosorbide Dinitrate | |
| Iso Mack Retard (Lithuania) | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 20 mg | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 40 mg | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 60 mg | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 80 mg | |
| Iso Mack Retard 20 mg x 20 Tablet | |
| Iso Mack Retard 20 mg x 100 Tablet | |
| Iso Mack Retard 40 mg x 100 Tablet | |
| Iso Mack Retard 20 mg (Lithuania) | |
| Iso Mack Retard 40 mg (Lithuania) | |
| Iso Mack Retard 60 mg (Lithuania) | |
| Iso Mack Spray (Vietnam) | |
| Iso Mack Spray 1.25 mg/0.09 mL x 20 mL | |
| ISO-10 | |
| ISO-10 10mg TAB / 20 | $ 0.30 |
| Iso-Bid (United States) | |
| Iso-Lacer Retard (Spain) | |
| Iso-Mack (Bahrain, Bulgaria, China, Lithuania) | |
| Iso-Puren (Germany) | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 20 mg (Alpharma-isis) | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 40 mg (Alpharma-isis) | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 60 mg (Alpharma-isis) | |
| Tablet; Oral; Isosorbide Dinitrate 5 mg (Alpharma-isis) | |
| Isobar (France, Philippines, Tunisia) | |
| Tablet; Oral; Methyclothiazide 5 mg; Triamterene 150 mg (Jean-marie) | |
| Isobar 30 Tablet (Jean-marie) | |
| Isobenil (Philippines) | |
| Isobenil 5 mg x 100's | |
| Isobenil 10 mg x 100's | |
| Isobid (Pakistan) | |
| Isobid 0.1 % x 5 tube x 5 mL | |
| Isobide (Japan, Taiwan) | |
| Isobide 10 mg x 500's | |
| Isobide 700 mg/1 mL x 1 mL | |
| Isobide / Weidar 10 mg x 1000's | |
| Isobide / Weidar 10 mg x 100 x 10's | |
| Isobin (Singapore) | |
| Isobinate (Thailand) | |
| Isobinate 10 mg x 500's (General Drugs House) | |
| Isobinate tab 10 mg 500's (General Drugs House) | |
| Isocard (Bahrain, Dominican Republic, France, Iraq, Lebanon, Libya, Luxembourg, Nigeria, Oman, Saudi Arabia, Sudan, United Arab Emirates, Yemen) | |
| Solution; Sublingual; Isosorbide Dinitrate 1.25 mg (Eastern pharmaceuticals) | |
| Spray; Sublingual; Isosorbide Dinitrate 1.25 mg (Eastern pharmaceuticals) | |
| Isocard-spray (France) | |
| Isocardide (Israel) | |
| Tablet; Oral; Isosorbide Dinitrate 20 mg (Sam-on) | |
| Tablet; Oral; Isosorbide Dinitrate 30 mg (Sam-on) | |
| Isochron | |
| Isocin (Taiwan) | |
| Isocin 0.1 % x 10 mL x 10's (Zee Laboratories Ltd) | |
See 1255 substitutes for Iso | |
References
- DailyMed. "ISOSORBIDE DINITRATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- PubChem. "ISOSORBIDE DINITRATE". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "ISOSORBIDE DINITRATE". http://www.drugbank.ca/drugs/DB00883 (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Iso are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Iso. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
Consumer reported useful
No survey data has been collected yetConsumer reported price estimates
No survey data has been collected yetConsumer reported time for results
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Information checked by Dr. Sachin Kumar, MD Pharmacology
