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isosorbide dinitrate
Apo-ISDN†, Cedocard Retard§, Cedocard SR†, Dilatrate-SR, Ismo Retard§, Isonate, Isorbid, Isordil, Isordil Tembids, Isordil Titradose, Isotrate, Novosorbide†, Sorbid SA§, Sorbichew§, Sorbitrate

isosorbide mononitrate
Elantan§, Imdur, Isib 60XL§, ISMO, Isotrate§, Modisal XL§, Monit§, Mono-Cedocard§, Monoket, Monosorb XL 60§

Pregnancy Risk Category C

How supplied
isosorbide dinitrate

Tablets:
5 mg, 10 mg, 20 mg, 30 mg, 40 mg
Tablets (S.L.):
2.5 mg, 5 mg, 10 mg
Tablets (chewable):
5 mg, 10 mg
Tablets (sustained-release):
40 mg
Capsules:
40 mg
Capsules (sustained-release):
40 mg
isosorbide mononitrate

Tablets:
10 mg, 20 mg
Tablets (extended-release):
30 mg, 60 mg, 120 mg

Action
Not completely known. Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may increase blood flow through the collateral coronary vessels.

Indications & dosage
Acute angina attacks (S.L. and chewable tablets of isosorbide dinitrate only), prophylaxis in situations likely to cause angina attacks--

Adults:
S.L. form--2.5 to 5 mg S.L. for prompt relief of angina pain, repeated q 5 to 10 minutes (maximum of three doses for each 30-minute period). For prophylaxis, 2.5 to 10 mg q 2 to 3 hours.
Chewable form
--5 to 10 mg, p.r.n., for acute attack or q 2 to 3 hours for prophylaxis, but only after initial test dose of 5 mg to determine risk of severe hypotension.
Oral form (isosorbide dinitrate)
--5 to 30 mg P.O. t.i.d. or q.i.d. for prophylaxis only (use smallest effective dose); 20 to 40 mg P.O. (sustained-release) q 6 to 12 hours.
Oral form (isosorbide mononitrate using Imdur)
--30 to 60 mg P.O. once daily upon arising; increased to 120 mg once daily after several days, if needed.
Oral form (isosorbide mononitrate using ISMO or Monoket)
--20 mg b.i.d. with the two doses given 7 hours apart.

Adverse reactions
CNS:
headache; dizziness; weakness.
CV:
orthostatic hypotension, tachycardia, palpitations, ankle edema, fainting, flushing.
GI:
nausea, vomiting.
Skin:
cutaneous vasodilation, rash.
Other:
sublingual burning.

Interactions
Drug-drug.
Antihypertensives: may increase hypotensive effects. Monitor closely during initial therapy.
Sildenafil:
may increase hypotensive effects. Avoid concomitant use.
Drug-lifestyle.
Alcohol use: may increase hypotension. Avoid concomitant use.

Effects on diagnostic tests
May interfere with serum cholesterol determination tests using the Zlatkis-Zak color reaction, causing a falsely decreased value.

Contraindications
Contraindicated in patients with hypersensitivity or idiosyncrasy to nitrates, severe hypotension, angle-closure glaucoma, increased intracranial pressure, shock, or acute MI with low left ventricular filling pressure.

Nursing considerations

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

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