ISOSORBIDE DINITRATE oral

Prescription under medical supervision


Therapeutic action

– Vasodilator, antianginal

Indications

– Prophylaxis and treatment of acute angina
– Adjunctive therapy in left-sided heart failure

Forms and strengths

– 5 mg sublingual tablet

Dosage

 Short-term prophylaxis of acute angina (sublingually)
Adult: 5 to 10 mg taken 10 minutes before a precipitating event (physical exertion, stress, etc.)

 Long-term prophylaxis of angina and treatment of heart failure (orally)
Adult: 5 to 40 mg 2 to 3 times daily 
Gradually increase the dose until effective. Do not stop treatment abruptly.

– Treatment of acute angina (sublingually)
Adult: 5 to 10 mg, to be repeated after 10 minutes if necessary

Duration

– According to clinical response

Contra-indications, adverse effects, precautions

– Do not administer to patients with obstructive cardiomyopathy, hypotension, shock.
– May cause: orthostatic hypotension (especially in elderly 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.
– Use the lowest effective dose in patients taking another nitrate derivative, a vasodilator or an antihypertensive drug and in elderly patients.
– Combination with antihypertensive drugs, diuretics, vasodilators and alcohol enhances hypotensive effects.
– Do not combine with sildenafil (risk of acute coronary syndrome).
– Pregnancy: not recommended (safety is not established)
– Breast-feeding: not recommended (safety is not established)

Remarks

– Sublingual tablet must be crunched first, then slowly dissolved under the tongue. Oral tablet must be swallowed whole.
– By sublingual route, antianginal effect appears within less than 10 minutes and persists for 1 to 2 hours.
– Sustained-release formulations are used for the long-term management of angina and the treatment of heart failure. The time interval between each administration depends on the preparations.
  Storage: below 25 °C -  -