ration
Isosorbide dinitrate is administered sublingually, intrabuccally, or PO.
Sublingual (intrabuccal) tablets: Do not crush or chew. Administer while patient is sitting.
Chewable tablets: Chew thoroughly before swallowing; do not crush chewable tablets before administering. Administer while patient is sitting. NOTE: Chewable tablets are no longer available in the US.
Extended-release tablets or capsules: Administer intact; should not be chewed. If headache occurs and cannot be effectively controlled, oral doses may be given with meals.
STORAGE
Generic:
- Protect from light
- Store at 77 degrees F
Dilatrate SR:
- Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
- Store in a dry place
Isochron:
- Store at controlled room temperature (between 68 and 77 degrees F)
IsoDitrate :
- Store at controlled room temperature (between 68 and 77 degrees F)
Isordil Titradose:
- Protect from light
- Store at room temperature (up to 77 degrees F)
Sorbitrate:
- Protect from light
- Store at room temperature (up to 77 degrees F)
Wesorbide :
- Protect from light
- Store at room temperature (up to 77 degrees F)
CONTRAINDICATIONS / PRECAUTIONS
General Information
Isosorbide dinitrate is contraindicated for use by patients with a hypersensitivity to isosorbide dinitrate or any its ingredients.
Hypotension, hypovolemia, orthostatic hypotension
Use isosorbide dinitrate with caution in patients with preexisting hypotension, particularly orthostatic hypotension, or in patients with hypovolemia (or dehydration), because the drug can worsen hypotension, cause tachycardia, and/or exacerbate angina. Severe idiosyncratic reactions have occurred with nitrates that have rarely resulted in fatalities.
Geriatric, syncope
Geriatric patients may have reduced baroceptor function; severe orthostatic hypotension may occur when vasodilators such as nitrates are administered. Clinical experience for organic nitrates reported in the literature identified a potential for severe hypotension and increased sensitivity to nitrates in the elderly, even at therapeutic doses. When dosing isosorbide dinitrate in the elderly, it may be prudent to start the dose at the low end of the dosing range and monitor the patients closely for hypotensive effects. Subsequent dosage adjustments should be made based on clinical response. According to the Beers Criteria, vasodilators are considered potentially inappropriate medications (PIMs) in older adults and should be used cautiously in this population since vasodilators may exacerbate episodes of syncope in individuals with a history of syncope.
Cardiomyopathy, myocardial infarction
Nitrates may also aggravate angina in patients with hypertrophic cardiomyopathy. Patients who are receiving isosorbide dinitrate therapy should be advised to report to the hospital emergency room if anginal pain does not subside after three sublingual doses. Such resistance may indicate the development of severe ischemia such as an acute myocardial infarction. Isosorbide dinitrate should be used cautiously in patients with recent myocardial infarction because drug-induced hypotension and/or tachycardia can worsen ischemia, and the effects of long-acting nitrates are difficult to terminate quickly.
Head trauma, increased intracranial pressure, intracranial bleeding
Isosorbide dinitrate should not be used in patients with increased intracranial pressure (e.g., recen |
