Because the hypotension associated with isosorbide dinitrate overdose is the result of venodilatation and arterial hypovolemiaprudent therapy in this situation should be directed toward increase in central fluid volume.
Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy. The inactive ingredients in each tablet are lactose, cellulose, and magnesium stearate.
Few well-controlled clinical trials of organic nitrates have been designed to detect rebound or withdrawal effects.
Cancer Support Smartphone Health Apps. A daily dose-free interval of at least 14 hours is advisable to minimize tolerance. No long-term studies in animals have been performed to evaluate the carcinogenic potential of isosorbide dinitrate.
There are no adequate, well-controlled studies in pregnant women. In industrial workers who have had long-term exposure to unknown presumably high doses of organic nitrates, tolerance clearly occurs.
Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Hypotension induced by isosorbide dinitrate may be accompanied by paradoxical bradycardia and increased angina pectoris.
The principal pharmacological action of isosorbide dinitrate is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins, especially the latter. Most controlled trials of multiple-dose oral ISDN taken every 12 hours or more frequently for several weeks have shown statistically significant anti-anginal efficacy for only 2 hours after dosing.
In clinical trials, immediate-release oral isosorbide dinitrate has been administered in a variety of regimens, with total daily doses ranging from 30 mg to mg. Attempts to overcome nitrate tolerance by dose escalation, even to doses far in excess of those used acutely, have consistently failed.
As with all titratable drugs, it is important to administer the minimum dose which produces the desired clinical effect. No data are available to suggest physiological maneuvers e. Dilatation of the coronary arteries also occurs.
Isordil Titradose is contraindicated in patients who are allergic to isosorbide dinitrate or any of its ingredients. The 5 mg and 40 mg dosage strengths also contain the following: Every dosing regimen for Isordil Titradose tablets must provide a daily dose-free interval to minimize the development of this tolerance. Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end- diastolic pressure and pulmonary capillary wedge pressure preload.
The relative importance of preload reduction, afterload reduction, and coronary dilatation remains undefined. Serum levels reach their maxima about an hour after ingestion.
Isordil isosorbide dinitrate Titradose tablets are indicated for the prevention of angina pectoris due to coronary artery disease. The importance of these observations to the routine, clinical use of immediate-release oral isosorbide dinitrate is not known.