Composition
Cap 40 mg/20 mg: Isosorbide dinitrate 40 mg/20 mg; sustained-release cap Inj: IV Infusion: Per ml: Isosorbide dinitrate 1 mg; 10 ml (10 mg) amp. Tab 10 mg/20 mg/40 mg: Isosorbide dinitrate 10
Indications & Dosage
Prophylaxis and treatment of angina: ORAL: Adult: 30-120 mg daily in divided doses. BY IV INF: Adult: 2-10 mg/hour, increased if necessary up to20 mg/hour. Left ventricular failure, Congestive heart failure: ORAL: Adult: 40-160 mg daily in divided doses, increased if necessary up to 240 mg daily in divided doses BY IV INF: Adult: Initially 2-10 mg/hour, increased if necessary upto 20 mg/hour Prophylaxis of angina: ORAL: Adult: 40 mg daily in 1-2 divided doses, increased if necessary to 60-80 mg daily in 2-3 divided doses.
Administration
By IV infusion diluted to a max concentration of 0.05% in NS or D5W. Also administered as an intra-coronary bolus inj during percutaneous transluminal coronary angioplasty
Contraindications
Hypersensitivity to nitrates; hypotensive conditions and hypovolaemia; hypertrophic cardiomyopathy; aortic stenosis; cardiac tamponade; constrictive pericarditis; mitral stenosis; toxic pulmonary oedema; head trauma; cerebral haemorrhage; cerebrovascular disease; marked anaemia.
Precautions
Hypothyroidism, malnutrition, hypothermia, recent history of myocardial infarction, heart failure due to obstruction, hypoxaemia or other ventilation and perfusion abnormalities, susceptibility to angle-closure glaucoma, metal-containing transdermal systems should be removed before magnetic resonance imaging procedures, cardioversion, or diathermy, avoid abrupt withdrawal, monitor blood pressure and heart rate during IV infusion.
Interactions
Sildenafil, tadalafil, vardenafil, ethanol, heparin, alteplase, ergot alkaloids.
Pregnancy
Caution advised, avoid unless potential benefit outweighs risk.
Lactation
Caution advised
Side Effects
Postural hypotension, tachycardia, paradoxical bradycardia, throbbing headache, dizziness, nausea, vomiting, heartburn, flushing, syncope, temporary hypoxaemia, rash. Rare: angle-closure glaucoma. Injection Specific side-effects include severe hypotension, diaphoresis, apprehension, restlessness, muscle twitching, retrosternal discomfort, palpitation, abdominal pain, prolonged administration has been associated with methaemoglobinaemia.