Isosorbide Dinitrate (Isordil or Isoket) is an antianginal and a nitrate

drug. Isordil relaxes vascular smooth muscle with a resultant decrease in venous
return and decrease in arterial BP, which reduces left ventricular workload and
decreases myocardial oxygen consumption.
Generic Names
isosorbide nitrates , isosorbide dinitrate , isosorbide mononitrate
Brand Names

Isordil,

Isordil Titradose ,

Imdur,

ISMO,

Isotrate ER,

Monoket

Classifications

Antianginal,

Nitrate,

Vasodilator

Pregnancy Category C

Dosage & Route

Adults
To avoid tolerance to drug, take short-acting products bid or tid with last dose no
later than 7 PM and SR products once daily or bid at 8 PM and 2 PM. This creates a
nitrate-free period.
Isosorbide dinitrate

Angina pectoris: Starting dose, 2.55 mg sublingual, 5-mg chewable tablets,

5- to 20-mg oral tablets. For maintenance, 1040 mg q 6 hr oral tablets or
capsules; SR, initially 40 mg, then 4080 mg PO q 812 hr.

Acute prophylaxis: Initial dosage, 510 mg sublingual or chewable tablets q

23 hr.

Isosorbide mononitrate

Prevention of angina: 20 mg PO bid given 7 hr apart; ER tablets3060

mg/day PO may be increased to 120 mg/day if needed. In smaller patients,
start with 5 mg (one-half of 10-mg tablet) but then increase to at least 10 mg
by day 2 or 3 of therapy. Give first dose when waking and second dose 7 hr
later. This creates a nitrate-free period and minimizes tolerance to drug.

Pediatric patients

Safety and efficacy not established.

Therapeutic actions
Isordil relaxes vascular smooth muscle with a resultant decrease in venous return
and decrease in arterial BP, which reduces left ventricular workload and decreases
myocardial oxygen consumption.
Indications

Dinitrate: Treatment and prevention of angina pectoris

Mononitrate: Prevention of angina pectoris

Unlabeled use (dinitrate): Used with hydralazine in patients with advanced

CHF

Adverse effects

CNS: Headache, apprehension, restlessness, weakness, vertigo, dizziness,

faintness

CV: Tachycardia, retrosternal discomfort, palpitations, hypotension, syncope,

collapse, orthostatic hypotension, angina, rebound hypertension, atrial
fibrillation, postural hypertension

Dermatologic: Rash, exfoliative dermatitis, cutaneous vasodilation with

flushing

GI: Nausea, vomiting, incontinence of urine and feces, abdominal pain,

diarrhea

GU: Dysuria, impotence, urinary frequency

Other: Muscle twitching, pallor, perspiration, cold sweat, arthralgia, bronchitis

Contraindications

Contraindicated with allergy to nitrates, severe anemia, head trauma,

cerebral hemorrhage, hypertrophic cardiomyopathy, narrow-angle glaucoma,
postdural hypotension

Use cautiously with pregnancy, lactation, acute MI, CHF.

Nursing considerations
[box type=alert]Name confusion has occurred between Isordil (isosorbide) and
Plendil (felodipine); use caution.[/box]
Assessment

History: Allergy to nitrates, severe anemia, GI hypermobility, head trauma,

cerebral hemorrhage, hypertrophic cardiomyopathy, pregnancy, lactation

Physical: Skin color, T, lesions; orientation, reflexes, affect; P, BP, orthostatic

BP, baseline ECG, peripheral perfusion; R, adventitious sounds; liver
evaluation, normal output; CBC, Hgb

Interventions

Give sublingual preparations under the tongue or in the buccal pouch;

discourage the patient from swallowing.

Create a nitrate-free period to minimize tolerance.

[box type=alert]WARNING: Give chewable tablets slowly, only 5 mg initially,

because severe hypotension can occur; ensure that patient does not chew or crush
sustained-release preparations.[/box]

Give oral preparations on an empty stomach, 1 hr before or 2 hr after meals;

take with meals if severe, uncontrolled headache occurs.

[box type=alert]WARNING: Keep life support equipment readily available if

overdose occurs or cardiac condition worsens.[/box]
[box type=alert]WARNING: Gradually reduce dose if anginal treatment is being
terminated; rapid discontinuation can lead to problems of withdrawal.[/box]
Teaching Points

Place sublingual tablets under your tongue or in your cheek; do not chew or
swallow the tablet. Take the isosorbide before chest pain begins, when
activities or situation may precipitate an attack. Take oral isosorbide dinitrate
on an empty stomach, 1 hour before or 2 hours after meals; do not chew or
crush sustained-release preparations; do not take isosorbide mononitrate to
relieve acute anginal episodes.

You may experience these side effects: Dizziness, lightheadedness (may be

transient; use care to change positions slowly); headache (lie down in a cool
environment, rest; over-the-counter preparations may not help; take drug
with meals); flushing of the neck or face (reversible).

Report blurred vision, persistent or severe headache, rash, more frequent or

more severe angina attacks, fainting.