ISOSORBIDE DINITRATE oral

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    Last updated: August 2021

     

    Prescription under medical supervision

     

    Therapeutic action

    • Vasodilator, antianginal

    Indications

    • Prophylaxis and treatment of acute angina
    • Treatment of left-sided or global chronic heart failure in patients with intolerance to angiotensin-converting enzyme (ACE) inhibitors
    • Adjunctive therapy in acute heart failure (acute pulmonary oedema) 

    Forms and strengths

    • 5 mg sublingual tablet

    Dosage

    Short-term prophylaxis of acute angina

    • Adult: 5 to 10 mg sublingually taken 10 minutes before a precipitating event (physical exertion, stress, etc.)

     

    Long-term prophylaxis of acute angina and treatment of left-sided or global chronic heart failure

    • Adult: 5 to 40 mg orally 2 to 3 times daily 

    Gradually increase the dose until effective. Do not stop treatment abruptly.

     

    Treatment of acute angina

    • Adult: 5 to 10 mg sublingually, to be repeated after 10 minutes if necessary

     

    Adjunctive therapy in acute heart failure (acute pulmonary oedema)

    • Adult: 5 mg sublingually, to be repeated after 10 minutes if necessary. The objective is to lower the systolic pressure to 120-150 mmHg and the diastolic pressure to under 110 mmHg.

    Duration

    • According to clinical response

    Contra-indications, adverse effects, precautions

    • Do not administer to patients with obstructive cardiomyopathy, hypotension, shock, severe anaemia, intracranial hypertension or neurologic injury.
    • May cause: 
      • orthostatic hypotension (especially in older patients), headache, nausea, flushing of the face, haemolytic anaemia in patients with G6PD deficiency;
      • severe hypotension with risk of circulatory collapse in the event of overdose.
    • Avoid combination or use the lowest effective dose in patients taking another nitrate derivative, a vasodilator, a diuretic or an antihypertensive drug (enhances hypotensive effects), and in older patients. 
    • Do not combine with sildenafil or other drugs used for erectile dysfunction (risk of severe hypotension, syncope and acute coronary syndrome).
    • Pregnancy: not recommended (safety is not established)
    • Breast-feeding: not recommended (safety is not established)

    Remarks

    • By sublingual route, antianginal effect appears within less than 10 minutes and persists for 1 to 2 hours.
    • Tolerance to nitrates develops with prolonged use and can be overcome by short periods of nitrate withdrawal, and not by dose escalation.
    • Sustained-release formulations are used for the long-term management of acute angina and the treatment of heart failure. The time interval between each administration depends on the preparations.

    Storage

     
    - 
     
    - Below 25 °C 
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