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Isosorbide Dinitrate (Isordil, Dilitrate-SR, Sorbitrate, Timecelles)

Category:

  • Cardiac

Description:

  • Antianginal agent

Indications:

  • Prevention of angina pectoris

  • Relief of acute anginal episodes and prophylaxis prior to events likely to provoke an attack

  • CHF (non-FDA approved)

  • Hypertension (acute) (non-FDA approved)

Contraindications:

  • Hypersensitivity to nitrates, severe anemia, close-angle glaucoma, postural hypotension

  • Head trauma

Precautions:

  • Pregnancy category C; use caution in nursing mothers

  • Acute MI, hypertrophic cardiomyopathy, glaucoma

  • Volume depletion, hypotension, abrupt withdrawal

  • Continuous delivery without nitrate-free interval (tolerance develops)

Adverse Reactions (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, PVC’s, 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, pruritis, rash

Dosage:

Administered orally: Asymmetric dosing regimens provide a daily nitrate-free interval to minimize the development of tolerance.

  • Adult:   

    • SL 2.5-5mg initially, titrate upward until angina is relieved or side effects limit the dose; 

    • chewable tablets 5mg initially, titrate upward until angina is relieved or side effects limit the dose; 

    • PO 5-20mg 2-3 times daily initially (last dose no later than 1900), maintenance 10-40mg 2-3 times daily (last dose no later than 1900); 

    • PO SUS REL 40mg 1-2 times daily initially (last dose no later than 1400), maintenance 40-80mg 1-2 times daily (last dose no later than 1400)

Special considerations:

  • Headache may be a marker for drug activity; do not try to avoid by altering treatment schedule; aspirin or acetaminophen may be used for relief

  • Dissolve SL tablets under tongue; do not crush, chew, or swallow

  • Do not crush chewable tablets before administering

  • Avoid alcohol

  • Make changes in position slowly to prevent fainting

 

 


The information contained here is an abbreviated summary. For more detailed and complete information, consult the manufacturer's product information sheets or standard textbooks

Source: Operational Medicine 2001,  Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This information is provided by The Brookside Associates.  The Brookside Associates, LLC. is a private organization, not affiliated with any governmental agency. The opinions presented here are those of the author and do not necessarily represent the opinions of the Brookside Associates or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. All material presented here is unclassified.

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