Isosorbide Dinitrate

A to Z Drug Facts

Isosorbide Dinitrate

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(EYE-sos-ORE-bide die-NYE-trate)

Dilatrate-SR, Isordil, Isordil Tembids, Isodril Titradose, Sorbitrate, APO-ISDN, Cedocard-SR

Class: Antianginal

Action Relaxation of smooth muscle of venous and arterial vasculature.

Indications Treatment and prevention of angina pectoris.

Contraindications Hypersensitivity to nitrates; severe anemia; closed-angle glaucoma; orthostatic hypotension; head trauma or cerebral hemorrhage.

Route/Dosage

Angina Pectoris

ADULTS: SL (sublingual tablets) 2.5 to 5 mg; PO (chewable tablets) 5 mg; PO (oral tablets) 5 to 40 mg q 6 hr; PO (sustained release tablets) 40 to 80 mg q 8 to 12 hr.

Acute Prophylaxis

ADULTS: PO (sublingual or chewable tablets) 5 to 10 mg q 2 to 3 hr.

Interactions

Alcohol: Severe hypotension and cardiovascular collapse. Aspirin: Increased nitrate concentration and actions. Dihydroergotamine: Increased systolic blood pressure and decreased antianginal effects.

Lab Test Interferences May cause false report of reduced serum cholesterol with Zlatkis-Zak color reaction.

Adverse Reactions

CV: Tachycardia; palpitations; hypotension; syncope; arrhythmias. CNS: Headache; apprehension; weakness; vertigo; dizziness; agitation; insomnia. DERM: Cutaneous vasodilation with flushing. EENT: Blurred vision. GI: Nausea; vomiting; diarrhea; dyspepsia. GU: Dysuria; urinary frequency; impotence. HEMA: Methemoglobinemia; hemolytic anemia. RESP: Bronchitis; pneumonia. OTHER: Arthralgia; perspiration; pallor; cold sweat; edema.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Special risk patients: Use with caution in patients with acute MI or CHF. Angina: May aggravate angina caused by hypertrophic cardiomyopathy. Orthostatic hypotension: May occur even with small doses; alcohol accentuates this reaction. Tolerance: Tolerance to vascular and antianginal effects may develop.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Sublingual tablets should be placed under tongue to dissolve. Do not swallow.
Chewable tablets should be chewed and swallowed. Do not crush before administering.
Oral dosage forms should be taken on empty stomach with full glass of water.
Store at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Monitor for headache, hypotension, tachycardia, decreased pulse rate, heart block, and decreased respiratory rate.
Monitor hemoglobin levels.

OVERDOSAGE: SIGNS & SYMPTOMS
	Hypotension, tachycardia, flushing, diaphoresis, headache, vertigo, palpitations, visual disturbances, nausea, vomiting, confusion, dyspnea

Patient/Family Education

Instruct patient not to chew sublingual tablets. Emphasize need to hold chewable tablets in mouth for 1 to 2 min and then chew thoroughly before swallowing, to allow for absorption.
Advise patient not to stop taking medication suddenly; withdrawal syndrome may occur.
Instruct patient to notify physician immediately or go to nearest hospital emergency department if chest pain persists or worsens after taking prescribed dose.
Advise patient to notify physician if effectiveness of therapy decreases over time; tolerance may develop.
Instruct patient to report the following symptoms to physician: Severe or persistent headache, blurred vision, dry mouth, dizziness, flushing.
Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
Instruct patient to avoid intake of alcoholic beverages or alcohol-containing products.