Trade names Isordil, others Routes ofadministration by mouth Molar mass 236.136 g/mol | AHFS/Drugs.com Monograph Formula C6H8N2O8 CAS ID 87-33-2 | |
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Pregnancycategory US: C (Risk not ruled out) ATC code C01DA08 (WHO) C05AE02 (WHO) Legal status In general: ℞ (Prescription only) IUPAC ID 1,4:3,6-dianhydro-2,5-di-O-nitro-D-glucitol | ||
How to pronounce isosorbide dinitrate isordil memorizing pharmacology flashcard
Isosorbide dinitrate (ISDN) is a medication used for heart failure, esophageal spasms, and to treat and prevent chest pain from not enough blood flow to the heart. It has been found to be particularly useful in heart failure due to systolic dysfunction together with hydralazine in black people. It is taken by mouth or under the tongue.
Contents
- How to pronounce isosorbide dinitrate isordil memorizing pharmacology flashcard
- Nitroglycerin isosorbide dinitrate mechanism clinical use toxicity
- Medical uses
- Side effects
- Society and culture
- References
Common side effects include headache, lightheadedness with standing, and blurred vision. Severe side effects include low blood pressure. It is unclear if use in pregnancy is safe for the baby. It should not be used together with medications within the sildenafil family. ISDN is in the nitrate family of medications and works by dilating blood vessels.
Isosorbide dinitrate was first written about in 1939. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. ISDN is available as a generic medication. The wholesale cost in the developing world is about 6.36 USD a month. In the United States it costs less than 25 USD per month. A long acting form exists.
Nitroglycerin isosorbide dinitrate mechanism clinical use toxicity
Medical uses
It is used for angina, in addition to other medications for congestive heart failure, and for esophageal spasms.
Long-acting nitrates can be more useful as they are generally more effective and stable in the short term.
Side effects
After long-term use for treating chronic conditions, tolerance may develop in patients, reducing its effectiveness. The mechanisms of nitrate tolerance have been thoroughly investigated in the last 30 years and several hypotheses have been proposed. These include:
- Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); fainting; fast or slow heartbeat; nausea; new or worsening chest pain; vomiting.
- Impaired biotransformation of ISDN to its active principle NO (or a NO-related species)
- Neurohormonal activation, causing sympathetic activation and release of vasoconstrictors such as endothelin and angiotensin II which counteract the vasodilation induced by ISDN
- Plasma volume expansion
- The oxidative stress hypothesis (proposed by Munzel et al. in 1995)
The last hypothesis might represent a unifying hypothesis, and an ISDN-induced inappropriate production of oxygen free radicals might induce a number of abnormalities which include the ones described above. Furthermore, nitrate tolerance is shown to be associated with vascular abnormalities which have the potential to worsen patients prognosis: these include endothelial and autonomic dysfunction. In the short run, ISDN can cause severe headaches, necessitating analgesic (very rarely up to morphine) administration for relief of pain, as well as severe hypotension, and, in certain cases, bradycardia. This makes some physicians nervous and should prompt caution when starting nitrate administration.
Society and culture
Isosorbide dinitrate is sold in the USA under the brand names Dilatrate-SR by Schwarz and Isordil by Valeant, according to FDA Orange Book. In the United Kingdom, Argentina, and Hong Kong, a trade name of it is Isoket. It is also a component of BiDil.