ISOSORBIDE DINITRATE oral

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 -  -