ISOSORBIDE DINITRATE

Indications & Dose:

Prophylaxis and treatment of angina

• BY MOUTH USING IMMEDIATE-RELEASE MEDICINES

Adult: 30–120 mg daily in divided doses l

• BY INTRAVENOUS INFUSION

Adult: 2–10 mg/hour, increased if necessary up to 20 mg/hour

Left ventricular failure

• BY MOUTH USING IMMEDIATE-RELEASE MEDICINES

Adult: 40–160 mg daily in divided doses, increased if necessary up to 240 mg daily in divided doses l

• BY INTRAVENOUS INFUSION

Adult: Initially 2–10 mg/hour, increased if necessary up to 20 mg/hour

Prophylaxis of angina

• BY MOUTH USING MODIFIED-RELEASE MEDICINES

Adult: 40 mg daily in 1–2 divided doses, increased if necessary to 60–80 mg daily in 2–3 divided doses

Children

Not recommended

Contraindications:

Hypersensitivity to nitrates, severe anemia, closed-angle glaucoma, postural hypotension, head trauma or cerebral hemorrhage (may increase intracranial pressure), acute MI or CHF (mononitrate)

Side Effects:

CNS: Agitation, anxiety, apprehension, confusion,dizziness, dyscoordination, headache,hypoesthesia, hypokinesia, insomnia, nervousness,nightmares, restlessness, vertigo, weakness

CV: Atrial fibrillation, cardiovascular collapse,crescendo angina, dysrhythmias, edema,hypotension (sometimes with paradoxical bradycardia and increased angina), palpitations,postural hypotension, premature ventricularcontractions, rebound hypertension, retrosternal discomfort, syncope, tachycardia

EENT: Blurred vision, diplopia

GI: Abdominal pain, diarrhea, dyspepsia, involuntary passing of feces, nausea, tenesmus, vomiting

GU: Dysuria, impotence, involuntary passing of urine, urinary frequency

HEME: Hemolytic anemia, methemoglobinemia

MS: Arthralgia, muscle twitching

SKIN: Cold sweat, crusty skin lesions, exfoliative dermatitis, flushing, pallor, perspiration, pruritus, rash

Cautions:

Precautions:

Acute MI, hypertrophic cardiomyopathy, glaucoma, volume depletion, hypotension, abrupt withdrawal, continuous delivery without nitrate-free interval (tolerance will develop)

Pregnancy: Excretion into breast milk unknown; use caution in nursing mothers

Interaction:

Drugs Alcohol: Exaggerated hypotension and cardiac collapse

Calcium channel blockers: Exaggerated symptomatic orthostatic hypotension

Dihydroergotamine: Increases the bioBrands Available with Cost of dihydroergotamine with resultant increase in mean standing systolic blood pressure: functional antagonism, decreasing effects

Sildenafil: Excessive hypotensive effects

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: