What is Isosorbide Dinitrate?
Preventing symptoms of angina (chest pain) caused by heart disease. Isosorbide Dinitrate extended-release capsules is used alone or with other medicines. Isosorbide Dinitrate 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.
Isosorbide Dinitrate 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.
Isosorbide Dinitrate indications
Angina Pectoris:Oral Tablet:
Prophylaxis of ischemic heart pain associated with coronary insufficiency. Isosorbide Dinitrate 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, Isosorbide Dinitrate 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. Isosorbide Dinitrate 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. Isosorbide Dinitrate 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 Isosorbide Dinitrate?
Use Isosorbide Dinitrate extended-release capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Take Isosorbide Dinitrate extended-release capsules by mouth on an empty stomach with a full glass of water (8 oz [240 mL]).
- Swallow Isosorbide Dinitrate extended-release capsules whole. Do not break, crush, or chew before swallowing.
- If you miss a dose of Isosorbide Dinitrate 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 Isosorbide Dinitrate extended-release capsules.
Uses of Isosorbide Dinitrate in details
Use: Labeled Indications
Angina pectoris, prevention: Prevention of angina pectoris due to coronary artery disease.
Note: Due to slower onset of action, Isosorbide Dinitrate 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, Isosorbide Dinitrate 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 Isosorbide Dinitrate in patients with chronic heart failure support the use of Isosorbide Dinitrate (in combination with hydralazine) in patients with intolerance to ACE inhibitor therapy.
Isosorbide Dinitrate description
Each tablet of Isosorbide Dinitrate 5 mg contains 5 mg of Isosorbide Dinitrate.
Each tablet of Isosorbide Dinitrate 10 mg contains 10 mg of Isosorbide Dinitrate.
Each sustained-release tablet of Isosorbide Dinitrate 20 mg contains 20 mg of Isosorbide Dinitrate.
Each sustained-release tablet of Isosorbide Dinitrate 40 mg contains 40 mg of Isosorbide Dinitrate.
Isosorbide Dinitrate dosage
As noted under "CLINICAL PHARMACOLOGY," multiple-dose studies with Isosorbide Dinitrate and other nitrates have shown that maintenance of continuous 24-hour plasma levels results in refractory tolerance. Every dosing regimen for Isosorbide Dinitrate tablets must provide a daily dose-free interval to minimize the development of this tolerance. With immediate-release Isosorbide Dinitrate, 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 Isosorbide Dinitrate 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 Isosorbide Dinitrate 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.
Isosorbide Dinitrate interactions
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What other drugs will affect Isosorbide Dinitrate?
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 Isosorbide Dinitrate.
Phosphodiesterase Inhibitors: A blood pressure lowering effect of Isosorbide Dinitrate 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 Isosorbide Dinitrate 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 Isosorbide Dinitrate therapy.
Dihydroergotamine: Isosorbide Dinitrate 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), Isosorbide Dinitrate (ISDN), Isosorbide Dinitrate mononitrate and others].
Isosorbide Dinitrate side effects
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What are the possible side effects of Isosorbide Dinitrate?
Adverse reactions to Isosorbide Dinitrate are generally dose-related, and almost all of these reactions are the result of Isosorbide Dinitrate'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 Isosorbide Dinitrate 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.
Isosorbide Dinitrate contraindications
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What is the most important information I should know about Isosorbide Dinitrate?
Do not use Isosorbide Dinitrate if you are taking sildenafil (Viagra). Serious, life-threatening side effects can occur if you take Isosorbide Dinitrate while you are using sildenafil.
You should not use this medication if you are allergic to Isosorbide Dinitrate, Isosorbide Dinitrate 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 Isosorbide Dinitrate, tell your doctor if you have congestive heart failure, low blood pressure, or kidney disease.
Isosorbide Dinitrate 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 Isosorbide Dinitrate. 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.
Isosorbide Dinitrate 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 Isosorbide Dinitrate suddenly. Stopping suddenly could cause a severe angina attack.
Active ingredient matches for Isosorbide Dinitrate:
Isosorbide Dinitrate
| Unit description / dosage (Manufacturer) | Price, USD |
| Tablet; Oral; Isosorbide Dinitrate 10 mg | |
| Tablet; Oral; Isosorbide Dinitrate 20 mg | |
| Tablet; Oral; Isosorbide Dinitrate 5 mg | |
| Tablet; Sublingual; Isosorbide Dinitrate 2.5 mg | |
| Tablet, Extended Release; Oral; Isosorbide Dinitrate 40 mg | |
| Tablet; Sublingual; Isosorbide Dinitrate 5 mg | |
| Tablet; Oral; Isosorbide Dinitrate 30 mg | |
| Tablet; Sublingual; Isosorbide Dinitrate 10 mg | |
| Tablet, Sublingual; Oral; Isosorbide Dinitrate 2.5 mg | |
| Tablet, Sublingual; Oral; Isosorbide Dinitrate 5 mg | |
| Isordil Titradose 40 mg tablet | $ 1.70 |
| Isordil 40 mg tablet | $ 1.58 |
| Dilatrate-sr 40 mg capsule | $ 1.48 |
| Isochron 40 mg tablet sa | $ 1.07 |
| Isosorbide Dinitrate CR 40 mg Controlled Release Tabs | $ 0.88 |
| Isosorbide Mononitrate 20 mg tablet | $ 0.78 |
| Isosorbide Mononitrate 10 mg tablet | $ 0.74 |
| Isordil Titradose 5 mg tablet | $ 0.68 |
| Isordil 5 mg tablet | $ 0.65 |
| Isosorbide dn 30 mg tablet | $ 0.53 |
| Isordil 10 mg tablet | $ 0.50 |
| Isosorbide Dinitrate 30 mg tablet | $ 0.50 |
| Cedocard-Sr 20 mg Sustained-Release Tablet | $ 0.44 |
| Isosorbide Dinitrate 10 mg tablet | $ 0.43 |
| Isosorbide Dinitrate 20 mg tablet | $ 0.43 |
| Isosorbide Dinitrate 2.5 mg Sublingual Tabs | $ 0.39 |
| Isosorbide Dinitrate 5 mg Sublingual Tabs | $ 0.21 |
| Isosorbide dn 2.5 mg tablet sl | $ 0.21 |
| Isosorbide dn 5 mg tablet sl | $ 0.21 |
| Isosorbide dn 20 mg tablet | $ 0.20 |
| Isosorbide Dinitrate 5 mg tablet | $ 0.17 |
| Isosorbide dn 10 mg tablet | $ 0.17 |
| Isosorbide dn 5 mg tablet | $ 0.17 |
| Apo-Isdn 30 mg Tablet | $ 0.09 |
| Apo-Isdn 5 mg Sublingual Tablet | $ 0.07 |
| Apo-Isdn 10 mg Tablet | $ 0.04 |
| Isosorbide Dinitrate tablet 20 mg/1 (Ncs Health Care Of Ky, Inc Dba Vangard Labs (US)) | |
| Isosorbide Dinitrate tablet 10 mg/1 (Par Pharmaceutical Inc. (US)) | |
| Isosorbide Dinitrate tablet 5 mg/1 (American Health Packaging (US)) | |
| Isosorbide Dinitrate tablet 2.5 mg/1 (West ward Pharmaceutical Corp (US)) | |
| Isosorbide Dinitrate tablet, extended release 40 mg/1 (Physicians Total Care, Inc. (US)) | |
| Isosorbide Dinitrate tablet 30 mg/1 (Av Kare, Inc. (US)) | |
List of Isosorbide Dinitrate substitutes (brand and generic names): | |
| Isosorbide Vannier (Argentina) | |
| Isosorbidedinitraat (Netherlands) | |
| Isosorbidedinitraat 5 PCH (Netherlands) | |
| Isosorbidedinitraat A (Netherlands) | |
| Isosorbidedinitraat AccordHealthcare (Netherlands) | |
| Isosorbidedinitraat Actavis (Netherlands) | |
| Isosorbidedinitraat Actavis Retard (Netherlands) | |
| Isosorbidedinitraat Aurobindo Retard (Netherlands) | |
| Isosorbidedinitraat CF (Netherlands) | |
| Isosorbidedinitraat Fagron (Netherlands) | |
| Isosorbidedinitraat FNA (Netherlands) | |
| Isosorbidedinitraat Merck (Netherlands) | |
| Isosorbidedinitraat PCH (Netherlands) | |
| Isosorbidedinitraat ratiopharm (Netherlands) | |
| Isosorbidedinitraat Retard | |
| Tablet, Retard; Oral; Isosorbide Dinitrate 20 mg | |
| Isosorbidedinitraat retard A (Netherlands) | |
| Isosorbidedinitraat Retard Mylan (Netherlands) | |
| Isosorbidedinitraat retard PCH (Netherlands) | |
| Isosorbidedinitraat retard Teva (Netherlands) | |
| Isosorbidedinitraat Sandoz (Netherlands) | |
| Isosorbidedinitraat Sandoz retard (Netherlands) | |
| Isosorbidedinitraat Tiofarma (Netherlands) | |
| Isosorbidemononitraat Aurobindo (Netherlands) | |
| Isostad (Austria) | |
| Isostad Retard | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 20 mg | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 40 mg | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 60 mg | |
| Isostat | |
| Isostenase (Germany) | |
| Tablet; Oral; Isosorbide Dinitrate 10 mg (Azupharma) | |
| Isostenase Retard | |
| 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 | |
| Isotard (Israel, United Kingdom) | |
| Isotrate (Thailand) | |
| Isotrate 10 mg x 50 x 10's (Berlin Pharm) | |
| Isotrate 10 mg x 100's (Berlin Pharm) | |
| Isotrate 10 mg x 500's (Berlin Pharm) | |
| Isotrate 20 mg x 100's (Berlin Pharm) | |
| ISOTRATE 10MG TABLET 1 strip / 10 tablets each (Berlin Pharm) | $ 1.37 |
| ISOTRATE 20MG TABLET 1 strip / 10 tablets each (Berlin Pharm) | $ 2.09 |
| Isotrate tab 10 mg 50 x 10's (Berlin Pharm) | |
| Isotrate 10mg Tablet (Berlin Pharm) | $ 0.14 |
See 710 substitutes for Isosorbide Dinitrate | |
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).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
