ISORDIL TITRADOSE TAB（ISOSORBIDE DINITRATE）
isosorbide dinitrate - Drug Summary
CLASSES
Nitrites and Nitrates, Plain
DEA CLASS
Rx
DESCRIPTION
Moderate- to long-acting oral organic nitrate; used for relief and prophylaxis of angina pectoris; also used as an adjunctive agent for CHF (off-label use); in combination with hydralazine, it improves mortality in patients with CHF, but to a lesser degree than observed with the first-line ACE inhibitor therapy for CHF.
COMMON BRAND NAMES
Dilatrate SR, Isochron, IsoDitrate, Isordil Titradose, Sorbitrate, Wesorbide
HOW SUPPLIED
Dilatrate SR Oral Cap ER: 40mg
Isochron/IsoDitrate/Isosorbide Dinitrate Oral Tab ER: 40mg
Isordil Titradose/Isosorbide Dinitrate/Sorbitrate/Wesorbide Oral Tab: 5mg, 10mg, 20mg, 30mg, 40mg
DOSAGE & INDICATIONS
For the prevention or treatment of angina pectoris due to coronary artery disease.
For long-term prevention of angina pectoris.
Oral dosage (immediate-release capsules or tablets)
Adults
The manufacturer recommends an initial dosage of 5 to 20 mg PO twice daily or 3 times daily. For maintenance therapy, 10 mg to 40 mg, 2 or 3 times daily has been suggested. Some patients require higher doses. One review has recommended a maintenance dosage of 10 to 60 mg PO, given twice daily or 3 times daily. The optimal dosage and frequency to maximize anginal efficacy and minimize nitrate tolerance have not been established. Although isosorbide dinitrate has been administered 4 times daily, significant nitrate tolerance has been associated with this regimen. In 1 study, tolerance was prevented by administering isosorbide dinitrate 3 times daily with a nitrate-free interval of 14 hours. For immediate-release ISDN, an interdosing (nitrate-free) interval of 14 hours is recommended to prevent nitrate tolerance. The optimal nitrate-free interval will vary with the individual patient, dose, and regimen. Doses administered in clinical studies have ranged from 30 to 480 mg/day. High-dose isosorbide dinitrate at a dosage of 120 mg PO 4 times daily was administered to 24 patients with anginal attacks that did not respond to 10 mg PO 4 times daily. Twenty of the patients tolerated and responded to this dose while 14 were maintained on this dose for a mean of 62 weeks; weekly anginal attacks fell by 74% (from 6.04 to 1.6 attacks/week). Exercise performance was not improved; however, patients reported an improvement in quality of life.
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 (sustained-release capsules or tablets)
Adults
Initially, 40 mg PO once daily. Dosage may be increased up to 160 mg/day PO. An interdosing interval of more than 18 hours may be necessary to avoid nitrate tolerance.
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 prevention of effort-induced or stress-induced angina.
Sublingual dosage (sublingual tablets)
Adults
A patient anticipating an activity that is likely to cause angina should take 2.5 to 5 mg SL about 15 minutes prior to the expected activity.
Geriatric
See adult dosage. In general, the initial dose for a |
