Formulary
Isosorbide dinitrate: Indications, Dosing, Side Effects and Interactions
Isosorbide dinitrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Isosorbide dinitrate: Indications, Dosing, Side Effects and Interactions
Isosorbide dinitrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Prophylaxis and treatment of angina**
- **Adult** (By Mouth Using Immediate-Release Medicines): 30-120 mg daily in divided doses.
- **Adult** (By Intravenous Infusion): 1-3 sprays, to be administered under tongue whilst holding breath, allow a 30 second interval between each dose.
**Left ventricular failure**
- **Adult** (By Mouth Using Immediate-Release Medicines): 40-160 mg daily in divided doses, increased if necessary up to 240 mg daily in divided doses.
- **Adult** (By Intravenous Infusion): Initially 2-10 mg/hour, increased if necessary up to 20 mg/hour.
**Prophylaxis of angina**
- **Adult** (By Mouth Using Modified-Release Medicines): 40 mg daily in 1-2 divided doses, increased if necessary to 60-80 mg daily in 2-3 divided doses.
Cautions
Heart failure due to obstruction; hypothermia; hypothyroidism; hypoxaemia; malnutrition; metal-containing transdermal systems should be removed before magnetic resonance imaging procedures, cardioversion, or diathermy; recent history of myocardial infarction; susceptibility to angle-closure glaucoma; tolerance; ventilation and perfusion abnormalities Cautions, further information Tolerance Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 12 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for 8-12 hours (usually overnight) in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate if prescribed a long-acting nitrate with persistent postural hypotension i.e. recurrent drop in systolic blood pressure 20 mmHg (risk of syncope and falls).
Contraindications
Aortic stenosis; cardiac tamponade; constrictive pericarditis; hypertrophic cardiomyopathy; hypotensive conditions; hypovolaemia; marked anaemia; mitral stenosis; raised intracranial pressure due to cerebral haemorrhage; raised intracranial pressure due to head trauma; toxic pulmonary oedema
Side effects
Common or very common Arrhythmias; asthenia; cerebral ischaemia; dizziness; drowsiness; flushing; headache; hypotension; nausea; vomiting Uncommon Circulatory collapse; diarrhoea; skin reactions; syncope Side-effects For isosorbide dinitrate Common or very common With oral use Peripheral oedema Rare or very rare With oral use Angioedema; angle closure glaucoma; hypoventilation; hypoxia; pituitary haemorrhage; Stevens-Johnson syndrome
Interactions
**Other interactions (4):**
- Concurrent intake of drugs with blood pressure lowering properties e.g.
- This might also occur with neuroleptics and tricyclic antidepressants.
- The concurrent intake of ISDN with ACE-inhibitors or arterial vasodilators could be a desirable interaction, unless the antihypertensive effects are excessive in which case consider reducing the...
- Sapropterin (Tetrahydrobiopterine, BH4) is a cofactor for nitric oxide synthetase.
Pregnancy
May cross placenta-manufacturers advise avoid unless potential benefit outweighs risk.
Breast feeding
No information available-manufacturers advise use only if potential benefit outweighs risk.
Hepatic impairment
In general, manufacturers advise caution in severe impairment.
Renal impairment
In general, manufacturers advise caution in severe impairment.
Medicinal forms
Solution,Tablet,Tablet,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
Inside MedNext for this topic
- 411 MedNext-authored chapters
- 80,000+ MCQ bank
- 15 study modes
- Growing visual cheat sheets
Study modes
- Notes
- MCQ
- Audio
- Video
- Visual
- 3D Anatomy
- Trace
- Flashcards
- Mnemonics
- Image Bank
- Clinical
- Microscopy
- Audio QBank
- Cadaver
- Book Match
Continue reading
Subject HubPharmacology Hub
All pharmacology resources in one place.
Drug SchedulesIndian Drug Schedules
Schedule H, H1, X and G classifications.
FormularyBrowse all drugs
Search 1,850+ drug profiles.
Study Isosorbide dinitrate in the MedNext app
Challenge yourself with targeted pharmacology MCQs on this drug class. Every explanation links back to the chapter that teaches the concept.
Start drug challengeExplore the full formulary

