geriatric patient should start at the low end of the dosing range. Adjust dosage based on clinical response. Some geriatric patients may be more sensitive to hypotensive effects of nitrates.
Oral dosage (chewable tablets)
NOTE: Chewable tablets are no longer commercially available in the United States.
Adults
A patient anticipating an activity that is likely to cause angina should chew one 5-mg tablet about 15 minutes prior to the expected activity.
Geriatric
See adult dosage. In general, the initial dose for a geriatric patient should start at the low end of the dosing range. Adjust dosage based on clinical response. Some geriatric patients may be more sensitive to hypotensive effects of nitrates.
For the treatment of acute episodes of angina.
Sublingual dosage (sublingual tablets)
Adults
SL nitroglycerin is first-line therapy. Because the onset of action of sublingual ISDN is significantly slower than that of SL nitroglycerin, use of SL ISDN to abort an episode of acute angina is only recommended in patients who fail to respond to SL nitroglycerin. If ISDN is used, a dose of 2.5 to 10 mg SL given as needed or every 2 to 3 hours is recommended.
Geriatric
See adult dosage. In general, the initial dose for a geriatric patient should start at the low end of the dosing range. Adjust dosage based on clinical response. Some geriatric patients may be more sensitive to hypotensive effects of nitrates.
Oral dosage (chewable tablets)
NOTE: Chewable tablets are no longer commercially available in the United States.
Adults
SL nitroglycerin is first-line therapy. Because the onset of action of chewable ISDN is longer than that of SL nitroglycerin, use of chewable ISDN to abort an episode of acute angina is only recommended in patients who fail to respond to SL nitroglycerin. A dose of 2.5 to 10 mg PO given as needed or every 2 to 3 hours is recommended.
For the treatment of congestive heart failure† due to systolic dysfunction.
NOTE: Isosorbide dinitrate, given in combination with hydralazine, is considered appropriate alternative therapy in patients with contraindications or intolerance to ACE inhibitors or angiotensin II blockers. In addition, hydralazine plus isosorbide dinitrate in combination with standard therapy is FDA-approved for the treatment of heart failure in black patients (see BiDil monograph). The following dosage guidelines are adapted from the 1994 Clinical Practice Guideline: Heart Failure: eva luation and Care of Patients with Left-Ventricular Systolic Dysfunction and the 2001 ACC/AHA Guidelines for the eva luation and Management of Chronic Heart Failure in Adults .
Oral dosage (immediate-release capsules or tablets)
Adults
Initially, 10 mg PO three times daily. Dosage may be increased at weekly intervals up to 40 mg PO three times daily. In the Veterans Affairs Vasodilator-Heart Failure Trial (VHeFT) II, the average maintenance dose was 100 mg/day. Although isosorbide dinitrate has been administered four times daily in clinical trials, three doses per day are recommended due to poor compliance with more frequent dosing as well as concerns about nitrate tolerance. A interdosing ('nitrate-free') interval of 14 hours has been shown to prevent nitrate tolerance in patients with angina pectoris.
Geriatric
See adult dosage. In general, the initial dose for an elderly patient should start at the low end of the dosing range. Adjust dosage based on clinical response. Some elderly patients may be more sensitive to hypotensive e |
