Name: ISDN

Why is this medication prescribed?

Isosorbide immediate-release tablets are used for the management of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Isosorbide extended-release (long-acting) tablets and extended-release capsules are used for the management of chest pain in people who have coronary artery disease. Isosorbide can only be used to prevent angina; it cannot be used to treat an episode of angina once it has begun. Isosorbide is in a class of medications called vasodilators. It works by relaxing the blood vessels so the heart does not need to work as hard and therefore does not need as much oxygen.

Other uses for this medicine

Isosorbide tablets are also used with other medications to treat heart failure. Talk to your doctor about the possible risks of using this medication for your condition.

This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Brand names

  • Dilatrate®-SR
  • Imdur®
  • Ismo®
  • Ismotic®
  • Isoditrate®
  • Isordil®
  • Monoket®




Recent use (within several days) of PDE-5 inhibitors (eg, avanafil, sildenafil, tadalafil, or vardenafil) may cause dangerously low hypotension; the time course of the interaction appears to be related to the PDE-5 inhibitor half-life

Severe anemia, shock, markedly low blood pressure (BP)

Concomitant administration with guanylate stimulator riociguat


Allergies to nitrates, head trauma/cerebral hemorrhage (potential contraindication), hypertrophic cardiomyopathy, increased intraocular pressure, postural hypotension, acute myocardial infarction (MI), congestive heart failure, hyperthyroidism

Inability to relieve chest pain after 3 doses may signal acute MI necessitating emergency management

Tolerance to extended-release formulation may develop, rendering formulation ineffective after a few weeks

Do not change brands unintentionally; formulations are not all bioequivalent

Severe hypotension, particularly with upright posture, may occur with even small doses; use with caution in patients who may be volume depleted or who are already hypotensive; hypotension induced by isosorbide dinitrate may be accompanied by paradoxical bradycardia and increased angina pectoris

Nitrate therapy may aggravate angina caused by hypertrophic cardiomyopathy

Treat drug-induced headache with aspirin or acetaminophen

Provide nitrate-free interval (10-12 hours or overnight) to prevent development of tolerance

Use supportive treatment in overdose

Avoid use of extended release formulation in acute MI or acute heart failure; adverse events are not easily reversible if they develop

Avoid use in patients with hypertrophic cardiomyopathy with outflow tract obstruction; nitrates may reduce preload, which may cause exacerbation of obstruction and cause hypotension or syncope and/or worsening of heart failure

Pregnancy & Lactation

Pregnancy category: C

Lactation: Unknown whether drug is distributed into breast milk

Pregnancy Categories

A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA:Information not available.

Patient Handout

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