Adult Dosing

Prevention of angina pectoris

• Immediate release
• Starting dose: 5-20 mg PO bid-tid
• Maintenance dose: 10-40 mg bid-tid
• Max: 480 mg/day

• Extended-release
• 40 mg bid (6 hrs apart)
• Max: 160 mg/day

Note:

• Maintain daily dose-free interval of at least 14 hrs (immediate-release) and 18 hrs (extended-release) to minimize tolerance

Acute angina pectoris

• 2.5-5 mg SL q5-10 min; Max 3 doses in 15-30 mins

Pediatric Dosing

• Safety and effectiveness in pediatric patients has not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Prevention and treatment of angina pectoris

• Hypersensitivity to any of the ingredients of the product
• Sildenafil, tadalafil, vardenafil

• N/A

Renal Dose Adjustments

• Renal impairment: No dose adjustments

Hepatic Dose Adjustments

• Hepatic impairment: Dose adjustments not defined

• Concomitant administration of sildenafil amplifies the vasodilatory effect of isosorbide dinitrate resulting in to severe hypotension. Treat this condition as nitrate overdose with elevation of the extremities and with central volume expansion
• The benefits of immediate-release or extended release oral isosorbide dinitrate in acute myocardial infarction or congestive heart failure have not been established. If used in this condition closely monitor clinical and hemodynamic conditions to avoid the hazards of hypotension and tachycardia, as it is difficult to terminate the effect of isosorbide dinitrate rapidly
• Even a small dose of isosorbide dinitrate can cause severe hypotension, particularly with upright posture. Hence use cautiously in volume depleted or hypotensive patients
• Isosorbide dinitrate induced hypotension is accompanied by paradoxical bradycardia and increased angina pectoris
• Angina caused by hypertrophic cardiomyopathy is aggravated by nitrate therapy
• Blunt exercise tolerance is observed with sublingual nitroglycerin therapy
• Administration of nitroglycerine for continuous 12 hrs of every 24-hour day, easily provoked anginal attacks, demonstrated hemodynamic rebound and decreased exercise tolerance during the interdosing intervals
• Long-term exposure to nitroglycerin demonstrates physical dependence and causes chest pain, acute myocardial infarction, and even sudden death during temporary withdrawal

Cautions: Use cautiously in

• Volume depletion
• Hypotension
• Acute MI
• CHF
• Hypertrophic cardiomyopathy

Dilatrate-SR, IsoDitrate, Isordil, Isordil Titradose interacts with :

	Adcirca
	Cialis
	Levitra
	Revatio
	Sildenafil
	Staxyn
	Tadalafil
	Vardenafil
	Viagra

Pregnancy Category:C

Breastfeeding: Safety unknown, manufacturer advises caution.

• CV: Hypotension, crescendo angina, rebound hypertension, tachycardia, paradoxical bradycardia
• CNS: Severe headache, light-headedness, syncope
• HEMA: Methemoglobinemia
• MISC: Tolerance/dependence

• Vasodilator agent; relaxes the vascular smooth muscle and consequent dilatates peripheral arteries and veins resulting in peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end- diastolic pressure and pulmonary capillary wedge pressure
• Metabolized by liver to 2-monohydrate and 5-mononitrate
• Renally excreted
• Half-life:
• isosorbide dinitrate: 1 hrs
• 5-mononitrate: 2 hrs
• 5-mononitrate: 5 hrs

US Trade Name(s)

• Dilatrate-SR
• IsoDitrate
• Isordil Titradose

US Availability

isosorbide dinitrate (generic)

• TABS: 5, 10, 20, 30 mg
• ETABS: 40 mg
• SL TABS: 2.5, 5 mg

Dilatrate-SR

• ECAPS: 40 mg

IsoDitrate

• ECAPS: 40 mg

Isordil Titradose

• TABS: 5, 10, 20, 30, 40 mg

Canadian Trade Name(s)

• ISDN
• Novo-sorbide

Canadian Availability

isosorbide (generic)

• TABS: 10, 30 mg

ISDN

• TABS: 5, 10, 30 mg

Novo-sorbide

• TABS: 10, 30 mg

UK Trade Name(s)

• Isoket Retard

UK Availability

isosorbide dinitrate (generic)

• TABS: 10, 20 mg

Isoket Retard

• ETABS: 20, 40 mg

Australian Trade Name(s)

• Isordil
• Sorbidin

Australian Availability

Isordil

• TABS: 10 mg
• SL TABS: 5 mg

Sorbidin

• TABS: 10 mg

[Outline]

Cardiovascular

Antianginal Agents

Nitrates

Pricing data from www.DrugStore.com in U.S.A.

• Isosorbide Dinitrate 5 MG TABS [Bottle] (SANDOZ)
  90 mg = $13.99
  180 mg = $17.97
• Isordil Titradose 40 MG TABS [Bottle] (VALEANT)
  60 mg = $113.99
  180 mg = $329.98
• Isordil Titradose 5 MG TABS [Bottle] (BTA PHARMACEUTICALS)
  100 mg = $64.99
  300 mg = $194.97
• Isosorbide Dinitrate 2.5 MG SUBL [Bottle] (WEST-WARD)
  100 mg = $19.99
  300 mg = $59.97
• Isosorbide Dinitrate 10 MG TABS [Bottle] (WEST-WARD)
  30 mg = $12.99
  90 mg = $29.66
• Isosorbide Dinitrate 5 MG SUBL [Bottle] (WEST-WARD)
  100 mg = $18.99
  300 mg = $55.97
• Isosorbide Dinitrate 20 MG TABS [Bottle] (WEST-WARD)
  30 mg = $12.99
  60 mg = $14.98

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

• Dilatrate 40 MG Extended Release Capsule (Schwartz Pharma)
• Dilatrate 40 MG Extended Release Capsule (Schwarz Pharma)
• Isordil 10 MG Sublingual Tablet (Wyeth Laboratories)
• Isordil 2.5 MG Sublingual Tablet (Wyeth Laboratories)
• Isordil 40 MG Oral Tablet (BTA Pharmaceuticals, Inc.)
• Isordil 5 MG Oral Tablet (BTA Pharmaceuticals, Inc.)
• Isordil 5 MG Sublingual Tablet (Wyeth Laboratories)
• Isosorbide Dinitrate 10 MG Oral Tablet (Hikma Pharmaceutical)
• Isosorbide Dinitrate 10 MG Oral Tablet (Par Pharmaceutical Inc.)
• Isosorbide Dinitrate 10 MG Oral Tablet (Sandoz Inc.)
• Isosorbide Dinitrate 10 MG Oral Tablet (State of Florida DOH Central Pharmacy)
• Isosorbide Dinitrate 10 MG Oral Tablet (West-ward Pharmaceutical Corp.)
• Isosorbide Dinitrate 20 MG Oral Tablet (Hikma Pharmaceutical)
• Isosorbide Dinitrate 20 MG Oral Tablet (Par Pharmaceutical Inc.)
• Isosorbide Dinitrate 20 MG Oral Tablet (Sandoz Inc.)
• Isosorbide Dinitrate 20 MG Oral Tablet (State of Florida DOH Central Pharmacy)
• Isosorbide Dinitrate 20 MG Oral Tablet (West-ward Pharmaceutical Corp.)
• Isosorbide Dinitrate 30 MG Oral Tablet (NCS HealthCare of KY, Inc dba Vangard Labs)
• Isosorbide Dinitrate 30 MG Oral Tablet (Par Pharmaceutical Inc.)
• Isosorbide Dinitrate 30 MG Oral Tablet (West-ward Pharmaceutical Corp.)
• Isosorbide Dinitrate 40 MG Extended Release Tablet (Amedra Pharmaceutical)
• Isosorbide Dinitrate 40 MG Extended Release Tablet (Caraco Pharmaceutical Laboratories Ltd.)
• Isosorbide Dinitrate 40 MG Extended Release Tablet (Corepharma LLC)
• Isosorbide Dinitrate 40 MG Extended Release Tablet (Inwood Laboratories, Inc.)
• Isosorbide Dinitrate 40 MG Extended Release Tablet (KAISER FOUNDATION HOSPITALS)
• Isosorbide Dinitrate 40 MG Extended Release Tablet (Rising Pharmaceuticals Inc)
• Isosorbide Dinitrate 5 MG Oral Tablet (Hikma Pharmaceutical)
• Isosorbide Dinitrate 5 MG Oral Tablet (Par Pharmaceutical Inc.)
• Isosorbide Dinitrate 5 MG Oral Tablet (Sandoz Inc.)
• Isosorbide Dinitrate 5 MG Oral Tablet (West-ward Pharmaceutical Corp.)