Psp Go Explore Maps Isosorbide
| Clinical data | |
|---|---|
| Trade names | Isordil, others[1] |
| Synonyms | (3R,3aS,6S,6aS)-hexahydrofuro[3,2-b]furan-3,6-diyl dinitrate |
| AHFS/Drugs.com | Monograph |
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| Routes of administration | by mouth |
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| Pharmacokinetic data | |
| Bioavailability | 10–90%, average 25% |
| Metabolism | Liver |
| Elimination half-life | 1 hour |
| Excretion | Kidney |
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| Chemical and physical data | |
| Formula | C6H8N2O8 |
| Molar mass | 236.136 g/mol g·mol−1 |
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Isosorbide dinitrate (ISDN) is a medication used for heart failure, esophageal spasms, and to treat and prevent chest pain from not enough blood flow to the heart.[1] It has been found to be particularly useful in heart failure due to systolic dysfunction together with hydralazine in black people.[2][1] It is taken by mouth or under the tongue.[1]
Common side effects include headache, lightheadedness with standing, and blurred vision.[1] Severe side effects include low blood pressure.[1] It is unclear if use in pregnancy is safe for the baby.[1] It should not be used together with medications within the sildenafil family.[1] ISDN is in the nitrate family of medications and works by dilating blood vessels.[1]
Information on the drug isosorbide mononitrate (Imdur, Ismo, Monoket), a nitrate used to treat angina pectoris (heart pain, chest pain). Side effects, drug interactions, and warnings and precautions are included in the information. Mar 12, 2019 Isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron) is a medication in the nitrate drug class. Isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron) is prescribed for the treatment of angina (heart pain), coronary artery disease, and congestive heart failure.
Alicia en el pais de los cuantos pdf download. Isosorbide dinitrate was first written about in 1939.[3] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[4] ISDN is available as a generic medication.[1] The wholesale cost in the developing world is about US$6.36 a month.[5] In the United States it costs less than US$25 per month.[6] A long acting form exists.[1]
Medical uses[edit]
It is used for angina, in addition to other medications for congestive heart failure, and for esophageal spasms.[1]
Long-acting nitrates can be more useful as they are generally more effective and stable in the short term.
Side effects[edit]
After long-term use for treating chronic conditions, tolerance may develop in patients, reducing its effectiveness. The mechanisms of nitrate tolerance have been thoroughly investigated in the last 30 years and several hypotheses have been proposed. These include:
- Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); fainting; fast or slow heartbeat; nausea; new or worsening chest pain; vomiting.
- Impaired biotransformation of ISDN to its active principle NO (or a NO-related species)
- Neurohormonal activation, causing sympathetic activation and release of vasoconstrictors such as endothelin and angiotensin II which counteract the vasodilation induced by ISDN
- Plasma volume expansion
- The oxidative stress hypothesis (proposed by Munzel et al. in 1995)
The last hypothesis might represent a unifying hypothesis, and an ISDN-induced inappropriate production of oxygen free radicals might induce a number of abnormalities which include the ones described above. Furthermore, nitrate tolerance is shown to be associated with vascular abnormalities which have the potential to worsen patients prognosis:[7] these include endothelial and autonomic dysfunction.[8] In the short run, ISDN can cause severe headaches, necessitating analgesic (very rarely up to morphine) administration for relief of pain, as well as severe hypotension, and, in certain cases, bradycardia. This makes some physicians nervous and should prompt caution when starting nitrate administration.
Mechanism of action[edit]
Similar to other nitrites and organic nitrates, isosorbide dinitrate is converted to nitric oxide (NO), an active intermediate compound which activates the enzyme guanylate cyclase (atrial natriuretic peptide receptor A). This stimulates the synthesis of cyclic guanosine 3',5'-monophosphate (cGMP) which then activates a series of protein kinase-dependent phosphorylations in the smooth muscle cells, eventually resulting in the dephosphorylation of the myosin light chain of the smooth muscle fiber. The subsequent sequestration of calcium ions results in the relaxation of the smooth muscle cells and vasodilation.[9]
Society and culture[edit]
Isosorbide dinitrate is sold in the US under the brand names Dilatrate-SR by Schwarz and Isordil by Valeant, according to FDA Orange Book. In the United Kingdom, Argentina, and Hong Kong, a trade name of it is Isoket. It is also a component of BiDil.
References[edit]
- ^ abcdefghijkl'Isosorbide Dinitrate/Mononitrate'. The American Society of Health-System Pharmacists. Archived from the original on 21 December 2016. Retrieved 8 December 2016.
- ^Chavey, William E.; Bleske, Barry E.; Van Harrison, R.; Hogikyan, Robert V.; Kesterson, Sean K.; Nicklas, John M. (1 April 2008). 'Pharmacologic management of heart failure caused by systolic dysfunction'. American Family Physician. 77 (7): 957–964. ISSN0002-838X. PMID18441861.
- ^Fischer, Janos; Ganellin, C. Robin (2006). Analogue-based Drug Discovery. John Wiley & Sons. p. 454. ISBN9783527607495. Archived from the original on 2016-12-20.
- ^'WHO Model List of Essential Medicines (19th List)'(PDF). World Health Organization. April 2015. Archived(PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
- ^'Isosorbide Dinitrate'. International Drug Price Indicator Guide. Retrieved 8 December 2016.
- ^Hamilton, Richart (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 160. ISBN9781284057560.
- ^(Nakamura et al.)
- ^(Gori et al.).
- ^Rang; et al. Pharmacology (8th ed.). Elsevier. p. 261. ISBN978-0-7020-5362-7.
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Medically reviewed by Drugs.com. Last updated on Nov 5, 2018.
Commonly used brand name(s)
In the U.S.
- Dilatrate-SR
- Isochron
- IsoDitrate
- Isordil Titradose
In Canada
- Apo-Isdn
- Isordil
Available Dosage Forms:
- Tablet
- Capsule, Extended Release
- Tablet, Extended Release
Therapeutic Class: Antianginal
Chemical Class: Nitrate
Uses for isosorbide dinitrate
Isosorbide dinitrate is used to prevent angina (chest pain) caused by coronary artery disease. It does not work fast enough to relieve the pain of an angina attack that has already started.
Isosorbide dinitrate belongs to the group of medicines called nitrates. It works by relaxing the blood vessels and increasing the supply of blood and oxygen to the heart while reducing its work load. When used regularly on a long-term basis, this helps prevent angina attacks from occurring.
Isosorbide dinitrate is available only with your doctor's prescription.
Before using isosorbide dinitrate
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For isosorbide dinitrate, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to isosorbide dinitrate or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of isosorbide dinitrate in the pediatric population. Safety and efficacy have not been established.
Geriatric
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of isosorbide dinitrate in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving isosorbide dinitrate.
Pregnancy
| Pregnancy Category | Explanation | |
|---|---|---|
| All Trimesters | C | Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women. |
Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Interactions with medicines
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking isosorbide dinitrate, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using isosorbide dinitrate with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Avanafil
- Riociguat
- Sildenafil
- Tadalafil
- Vardenafil
Interactions with food/tobacco/alcohol
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other medical problems
The presence of other medical problems may affect the use of isosorbide dinitrate. Make sure you tell your doctor if you have any other medical problems, especially:
- Congestive heart failure or
- Heart attack, recent or
- Hypertrophic cardiomyopathy (a heart disease) or
- Hypotension (low blood pressure) or
- Hypovolemia (low amount of blood)—Use with caution. May make these conditions worse.
Psp Go Explore Maps Isosorbide Free
Proper use of isosorbide dinitrate
Take isosorbide dinitrate exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
This form of nitrate is used to reduce the number of angina attacks over a long time. It will not relieve an attack that has already started because it works too slowly. The extended-release form releases medicine gradually to provide its effect for 8 to 10 hours. Check with your doctor if you also need a fast-acting medicine to relieve the pain of an angina attack.
You should take isosorbide dinitrate first thing in the morning and follow the same schedule each day. Isosorbide dinitrate works best if you have a 'drug-free' period of time every day when you do not take it. Your doctor will schedule your doses during the day to allow for a drug-free time. Follow the schedule of dosing carefully so the medicine will work properly.
Sublingual tablets should not be chewed, crushed, or swallowed. They work much faster when absorbed through the lining of the mouth. Place the tablet under the tongue and let it dissolve there. Do not eat, drink, smoke, or use chewing tobacco while a tablet is dissolving.
Swallow the extended-release tablet or capsule whole. Do not split, crush, or chew it.
Dosing
The dose of isosorbide dinitrate will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of isosorbide dinitrate. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For angina prevention:
- For oral dosage forms (extended-release tablets or sustained-release capsules):
- Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 160 mg per day.
- Children—Use and dose must be determined by your doctor.
- For oral dosage form (tablets):
- Adults—At first, 5 to 20 milligrams (mg) two or three times a day. Your doctor may increase your dose as needed.
- Children—Use and dose must be determined by your doctor.
- For sublingual dosage form (tablets):
- Adults—2.5 to 5 milligrams (mg) about 15 minutes before expected physical or emotional stress.
- Children—Use and dose must be determined by your doctor.
- For oral dosage forms (extended-release tablets or sustained-release capsules):
Missed dose
If you miss a dose of isosorbide dinitrate, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.
Ask your healthcare professional how you should dispose of any medicine you do not use.
Precautions while using isosorbide dinitrate
If you will be taking isosorbide dinitrate for a long time, it is very important that your doctor check your progress at regular visits to make sure that isosorbide dinitrate is working properly. Blood tests may be needed to check for unwanted effects.
Do not take avanafil (Stendra®), riociguat (Adempas®), sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®) while you are using isosorbide dinitrate. Using these medicines together may cause blurred vision, dizziness, lightheadedness, or fainting. If you are taking these medicines and you experience an angina attack, you must go to the hospital right away.
Isosorbide dinitrate may cause headaches. These headaches are a sign that the medicine is working. Do not stop using the medicine or change the time you use it in order to avoid the headaches. If you have severe pain, talk with your doctor.
Dizziness, lightheadedness, or faintness may occur, especially when you get up quickly from a lying or sitting position. Getting up slowly may help.
Dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, exercise, or if the weather is hot. While you are taking isosorbide dinitrate, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time.
Do not stop using isosorbide dinitrate without checking first with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely.
Isosorbide dinitrate side effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Rare
Sony Psp Go Explore Maps
- Bluish-colored lips, fingernails, or palms
- dark urine
- difficulty with breathing
- dizziness or lightheadedness
- fever
- headache
- pale skin
- rapid heart rate
- sore throat
- unusual bleeding or bruising
- unusual tiredness or weakness
Incidence not known
- Arm, back, or jaw pain
- blurred vision
- chest pain or discomfort
- chest tightness or heaviness
- confusion
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- fainting
- fast or irregular heartbeat
- sweating
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
- Blurred or loss of vision
- bulging soft spot on the head of an infant
- change in consciousness
- change in the ability to see colors, especially blue or yellow
- cold, clammy skin
- convulsions
- disturbed color perception
- double vision
- fast, irregular, pounding, or racing heartbeat or pulse
- feeling of constant movement of self or surroundings
- halos around lights
- headache, severe and throbbing
- increased sweating
- loss of appetite
- loss of consciousness
- nausea
- night blindness
- overbright appearance of lights
- paralysis
- sensation of spinning
- slow heartbeat
- tunnel vision
- vomiting
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Psp Go Explore Maps Isosorbide 2
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
See also:
Isosorbide dinitrate side effects (in more detail)
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Copyright 2019 Truven Health Analytics, Inc. All Rights Reserved.
More about isosorbide dinitrate
Consumer resources
Other brands:Isordil, Isordil Titradose, Dilatrate-SR, IsoDitrate, Isochron