Isosorbide dinitrate warnings and precautions: Difference between revisions
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==Warnings | ==Warnings== | ||
Amplification of the [[vasodilator]]y effects of ISDN by [[sildenafil]] can result in severe hypotension. The time course and dose dependence of this interaction have not been studied. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a [[nitrate]] overdose, with elevation of the extremities and with central volume expansion. | |||
The benefits of immediate-release oral ISDN in patients with [[acute myocardial infarction]] or [[congestive heart failure]] have not been established. If one elects to use ISDN in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of [[hypotension]] and [[tachycardia]]. Because the effects of oral ISDN are so difficult to terminate rapidly, this formulation is not recommended in these settings. | |||
==PRECAUTIONS== | |||
===General=== | |||
Severe [[hypotension]], particularly with upright posture, may occur with even small doses of ISDN. This drug should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already [[hypotensive]]. [[Hypotension]] induced by ISDN may be accompanied by paradoxical [[bradycardia]] and increased [[angina pectoris]]. | |||
Nitrate therapy may aggravate the angina caused by [[hypertrophic cardiomyopathy]]. | |||
As tolerance to ISDN develops, the effect of sublingual [[nitroglycerin]] on exercise tolerance, although still observable, is somewhat blunted. | |||
Some clinical trials in angina patients have provided nitroglycerin for about 12 continuous hours of every 24-hour day. During the daily dose-free interval in some of these trials, [[anginal]] attacks have been more easily provoked than before treatment, and patients have demonstrated [[hemodynamic]] rebound and decreased exercise tolerance. The importance of these observations to the routine, clinical use of immediate-release oral ISDN is not known. | |||
In industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs. [[Chest pain]], [[acute myocardial infarction]], and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating the existence of true physical dependence.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = ISORDIL (ISOSORBIDE DINITRATE) TABLET [BTA PHARMACEUTICALS, INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=abb3ad49-73a8-49c5-adc5-164d052971d7 | publisher = | date = | accessdate = 30 January 2014 }}</ref> | |||
==References== | ==References== | ||
Revision as of 04:05, 31 January 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]
Warnings
Amplification of the vasodilatory effects of ISDN by sildenafil can result in severe hypotension. The time course and dose dependence of this interaction have not been studied. Appropriate supportive care has not been studied, but it seems reasonable to treat this as a nitrate overdose, with elevation of the extremities and with central volume expansion.
The benefits of immediate-release oral ISDN in patients with acute myocardial infarction or congestive heart failure have not been established. If one elects to use ISDN in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of hypotension and tachycardia. Because the effects of oral ISDN are so difficult to terminate rapidly, this formulation is not recommended in these settings.
PRECAUTIONS
General
Severe hypotension, particularly with upright posture, may occur with even small doses of ISDN. This drug should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive. Hypotension induced by ISDN may be accompanied by paradoxical bradycardia and increased angina pectoris.
Nitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy.
As tolerance to ISDN develops, the effect of sublingual nitroglycerin on exercise tolerance, although still observable, is somewhat blunted.
Some clinical trials in angina patients have provided nitroglycerin for about 12 continuous hours of every 24-hour day. During the daily dose-free interval in some of these trials, anginal attacks have been more easily provoked than before treatment, and patients have demonstrated hemodynamic rebound and decreased exercise tolerance. The importance of these observations to the routine, clinical use of immediate-release oral ISDN is not known.
In industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs. Chest pain, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating the existence of true physical dependence.[1]
References
- ↑ "ISORDIL (ISOSORBIDE DINITRATE) TABLET [BTA PHARMACEUTICALS, INC.]". Retrieved 30 January 2014.