Pharm

Long Acting Nitroglycerin

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Long Acting Nitroglycerin, Long Acting Nitrates, Isosorbide, Isosorbide Mononitrate, Isosorbide Dinitrate, Imdur

  • See Also
  1. Transdermal Nitroglycerin
  • General
  1. Need 10-12 hours Nitroglycerin free interval per day
  2. Not proven to reduce Incidence of future events
  • Indications
  1. Chronic Angina Pectoris prophylaxis
    1. Not indicated for acute Myocardial Ischemia
  2. Congestive Heart Failure (not FDA approved)
    1. Combine with Hydralazine
  • Precautions
  1. Nitrate free period of 10-14 hours per day prevents the development of nitrate tolerance
  2. Swallow whole and do not crush or chew
  • Dosing
  1. Isosorbide Dinitrate (Isordil)
    1. Regular
      1. Start 5 to 20 mg orally three times daily (7am, 12 noon, 5pm)
      2. Maximum: 40 mg orally three times daily
    2. Sustained Release
      1. Start 40 mg orally twice daily (8 am, 3 pm)
      2. Maximum: 80 mg orally twice daily
  2. Isosorbide Mononitrate (Imdur)
    1. Regular
      1. Start 20 mg orally twice daily (8 am, 3 pm)
    2. Extended Release
      1. Start 30 mg orally daily
      2. May advance to 60 mg orally daily
      3. Maximum: 240 mg/day (maximum dose is rarely indicated)
  • Pharmacokinetics
  1. Isosorbide Dinitrate (Isordil) Regular Sublingual
    1. Onset: 5 minutes
    2. Duration: 1 to 4 hours
  2. Isosorbide Dinitrate (Isordil) Regular Oral
    1. Onset: 30 minutes
    2. Duration: 4 to 6 hours
  3. Isosorbide Dinitrate (Isordil) Sustained Release Oral
    1. Onset: 30 minutes
    2. Duration: 8 hours
  • Adverse Effects
  1. See Nitroglycerin
  • Mechanism
  1. See Nitroglycerin
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Resources
  1. Isosorbide Mononitrate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ae8f74f0-e600-4452-8557-958b603e2709
  2. Isosorbide Dinitrate (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=5c94ecc0-fcaa-4af3-82c2-ff124f2df3e1
  • References
  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 70-1
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia