Organic nitrate
Isosorbide dinitrate
Brand names: Isoket, Cedocard
Adult dose
Dose: PO 30–120mg/day in divided doses (give twice-daily nitrate-free interval). IV: 2–10mg/h titrated to BP
Route: PO/IV
Frequency: divided
Clinical pearls
- Acute coronary syndrome IV; chronic angina prophylaxis
- Provide nitrate-free interval to prevent tolerance
Contraindications
- Marked hypotension
- Severe aortic stenosis
- HOCM
- Concurrent PDE-5 inhibitors
- Closed-angle glaucoma
Side effects
- Headache
- Flushing
- Hypotension
- Tachycardia
- Tolerance
Interactions
- PDE-5 inhibitors (severe hypotension)
- Riociguat
Monitoring
- BP
- HR
Reference: BNF; ESC; https://bnf.nice.org.uk/drugs/isosorbide-dinitrate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines