Isosorbide Dinitrate

Isosorbide Dinitrate is a prescription medication used to treat Angina Pectoris (Chest Pain). 

• Isosorbide Dinitrate is available under the following different brand names: Dilatrate-SR, Isordil, Isordil Titradose, ISDN. 

Adult dosage

Capsule/tablet, extended release

• 40mg

Tablet, sublingual

• 2.5mg
• 5mg

Tablet

• 5mg
• 10mg
• 20mg
• 30mg
• 40mg

Angina Pectoris 

Adult dosage

• Immediate release: 5-20 mg orally every 8-12 hours initially; maintenance: 10-40 mg orally every 8-12 hours
• Extended release: 40 mg orally initially; maintenance: 40-80 mg orally every 8-12 hours
• SL (prophylaxis): 2.5-5 mg 15 minutes before performing activities likely to cause angina
• SL (treatment): 2.5-5 mg; may be repeated every 5-10 minutes; not to exceed 3 doses in 15-30 minutes

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Isosorbide Dinitrate include:

• headache, and
• flushing (warmth, redness, or tingly feeling)

Serious side effects of Isosorbide Dinitrate include:

• hives, 
• difficult breathing, 
• swelling of the face, lips, tongue, or throat, 
• lightheadedness, 
• worsening chest pain, 
• irregular heart rate, 
• pounding heartbeats, and
• fluttering in the chest

Rare side effects of Isosorbide Dinitrate include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Isosorbide Dinitrate has severe interactions with the following drugs:
  • avanafil
  • riociguat
  • sildenafil
  • tadalafil
  • vardenafil 
• Isosorbide Dinitrate has serious interactions with at least 16 other drugs.
• Isosorbide Dinitrate has moderate interactions with at least 34 other drugs.
• Isosorbide Dinitrate has minor interactions with the following drugs:
  • acetylcysteine (Antidote)
  • rifampin
  • rifapentine 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity 
• Recent use (within several days) of PDE-5 inhibitors (e.g., avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life
• Severe anemia, shock, markedly low blood pressure (BP)
• Concomitant administration with guanylate stimulator riociguat

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Isosorbide Dinitrate?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Isosorbide Dinitrate?”

Cautions

• Allergies to nitrates, head trauma/cerebral hemorrhage (potential contraindication), hypertrophic cardiomyopathy, increased intraocular pressure, postural hypotension, acute myocardial infarction (MI), congestive heart failure, hyperthyroidism
• Inability to relieve chest pain after 3 doses may signal acute MI necessitating emergency management
• Tolerance to extended-release formulation may develop, rendering formulation ineffective after a few weeks
• Do not change brands unintentionally; formulations are not all bioequivalent
• Severe hypotension, particularly with upright posture, may occur with even small doses; use with caution in patients who may be volume depleted or who are already hypotensive; hypotension induced by isosorbide dinitrate may be accompanied by paradoxical bradycardia and increased angina pectoris
• Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy
• Treat drug-induced headache with aspirin or acetaminophen
• Provide nitrate-free interval (10-12 hours or overnight) to prevent development of tolerance
• Use supportive treatment in overdose
• Avoid use of extended release formulation in acute MI or acute heart failure; adverse events are not easily reversible if they develop
• Avoid use in patients with hypertrophic cardiomyopathy with outflow tract obstruction; nitrates may reduce preload, which may cause exacerbation of obstruction and cause hypotension or syncope and/or worsening of heart failure.

Pregnancy and Lactation

• Use with caution if benefits outweigh risks during pregnancy.
• Lactation: Unknown whether the drug is distributed into breast milk.