Brand name: Isordil

Generic name: Isosorbide dinitrate

Indication: prevention and treatment of angina pectoris, for congestive heart failure, to
relieve pain, dysphagia and spasm in esophageal spasm with GE reflux.
Drug classification: antianginal agent, nitrate, vasodilator, coronary
Mechanism of action: stimulation of intracellular cystic- GMP results in vascular
smooth muscle relaxation of both arterial and venous vasculature. Increased
venous pooling decreases ventricular pressure (pre-load) and arterial dilatation
decreases arterial resistance (afterload). Therefore this reduces cardiac oxygen
demand by decreasing left ventricular pressure and systematic vascular
resistance by dilating arteries. Additionally, coronary artery dilation improves
collateral flow to ischemic regions; esophageal smooth muscle is relaxed via the
same mechanism.
Dosage: angina pectoris oral 5-30mg qid. Sublingual 5-10mg 2-3 hourly. Acute CHF oral
10- 40mg qid. Sublingual 5-10mg 2 hourly. chronic CHF initially 5-10 mg daily
2 hourly sublingually. maintenance 20-40mg qid orally.
Special precaution: tolerance and cross tolerance to other nitrate and nitrites may occur.
Pregnancy, lactation and children. Patients prone to or affected by hypotension
 or vol. depletion; severe hypotensive response; paradoxical bradycardia,
increased angina may accompany nitrate induced hypotension, hypertrophic
cardiomyopathy.
Pregnancy risk factor: C
Adverse reactions: flushing, vascular headache, cerebral ischemia associated with
postural hypotension, nausea, vomiting, weakness, restlessness, palor,
perspiration and collapse, drug rash and or exfoliative dermatitis.
Contraindications:hypersensitivity
Form: tab 5mg x 100s, 500s; 10mg x 100s, 500s
Sublingual tab 5mg x 100s
Nursing responsibilities:
 Inform or educate patient not to chew crush sublingual or sustained release
dosage form
 Do not change brands without consulting the physician or pharmacist, keep
tablets or capsules in original container tightly closed.
 8 to 12 hour nitrate free interval is needed each day to prevent tolerance