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{{drugbox |
__NOTOC__
|IUPAC_name = (3''R'',3a''S'',6''S'',6a''S'')-hexahydrofuro[3,2-''b'']furan-3,6-diyl dinitrate
{{Isosorbide dinitrate}}
|image = Isosorbide dinitrate_svg.png
{{CMG}}; {{AE}} {{PB}}
| width = 192
|CAS_number = 87-33-2
| ATC_prefix=C01
| ATC_suffix=DA08
| ATC_supplemental={{ATC|D03|AX08}}
| PubChem=3780
| DrugBank=APRD00455
| C = 6 | H = 8 | N = 2 | O = 8
|molecular_weight = 236.136 g/mol
|bioavailability = 10–90%, average 25%
|metabolism = [[Liver|Hepatic]]
|elimination_half-life = 1 hour
|excretion = [[Kidney|Renal]]
|pregnancy_US = C
|legal_status = Rx-only
|routes_of_administration = Oral
}}
{{CMG}}
 


'''''For patient information, click <u>[[Isosorbide dinitrate (patient information)|here]]'''''</u>.


==Overview==
==Overview==
'''Isosorbide dinitrate''' (ISDN) is a [[nitrate]] used [[pharmacology|pharmacologically]] as a [[vasodilation|vasodilator]], e.g. in [[angina pectoris]] but also for [[anal fissure]], a condition which is known to involve decreased blood supply leading to poor healing.  It is also used as a direct vasodilator to treat congestive heart failure.
Isosorbide dinitrate is sold under the brand names Isordil®<ref>[http://www.biovail.com/english/products/default.asp?s=1&product=433&viewer=doctor&state=displayProduct&country=USA Products<!-- Bot generated title -->]</ref> by [[Biovail]], Cedocard® and Sorbitrate®.  It is also a component of [[BiDil]].
==Uses==
It is more useful in preventing [[Angina pectoris|angina]] attacks than reversing them once they have commenced.  It may be given as a tablet for the treatment of an angina attack.


==Advantages==
==Category==


Long acting nitrates can be more useful as they are generally more effective and stable in the short term.
==US Brand Names==


==Disadvantages==
==FDA Package Insert==
After long term use for treating chronic conditions, tolerance may develop in a patient 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:
# Impaired biotransformation of ISDN to its active pinciple 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).


Recent evidence suggests that the latter 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.
'''| [[Isosorbide dinitrate indications and usage|Indications and Usage]]'''
Furthermore, studies have shown that nitrate tolerance is associated with vascular abnormalities which have the potential to worsen patients prognosis (Nakamura et al): these include endothelial and autonomic dysfunction (Gori et al). 
'''| [[Isosorbide dinitrate dosage and administration|Dosage and Administration]]'''
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.
'''| [[Isosorbide dinitrate dosage forms and strengths|Dosage Forms and Strengths]]'''
'''| [[Isosorbide dinitrate contraindications|Contraindications]]'''
'''| [[Isosorbide dinitrate warnings|Warnings and Precautions]]'''
'''| [[Isosorbide dinitrate adverse reactions|Adverse Reactions]]'''
'''| [[Isosorbide dinitrate drug interactions|Drug Interactions]]'''
'''| [[Isosorbide dinitrate use in specific populations|Use in Specific Populations]]'''
'''| [[Isosorbide dinitrate overdosage|Overdosage]]'''
'''| [[Isosorbide dinitrate description|Description]]'''
'''| [[Isosorbide dinitrate clinical pharmacology|Clinical Pharmacology]]'''
'''| [[Isosorbide dinitrate nonclinical toxicology|Nonclinical Toxicology]]'''
'''| [[Isosorbide dinitrate clinical studies|Clinical Studies]]'''
'''| [[Isosorbide dinitrate how supplied storage and handling|How Supplied/Storage and Handling]]'''
'''| [[Isosorbide dinitrate patient counseling information|Patient Counseling Information]]'''
'''| [[Isosorbide dinitrate labels and packages|Labels and Packages]]'''


== Notes ==
==Mechanism of Action==
<references/>
<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==


{{Antianginals (nitrates)}}
{{Reflist|2}}
{{Preparations for treatment of wounds and ulcers}}


[[Category:Nitrates]]
[[Category:Antianginals]]
[[Category:Drugs]]
[[Category:Drugs]]
[[de:Isosorbiddinitrat]]
[[pl:Diazotan izosorbidu]]
[[pt:Dinitrato de Isossorbida]]
[[th:ไอโซซอร์ไบด์ไดไนเตรต]]
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Revision as of 18:47, 30 January 2014

Isosorbide dinitrate
ISORDIL® FDA Package Insert
Indications and Usage
Dosage and Administration
Contraindications
Warnings and Precautions
Adverse Reactions
Drug Interactions
Overdosage
Description
Clinical Pharmacology
Clinical Studies
How Supplied/Storage and Handling
Patient Counseling Information
Labels and Packages
Clinical Trials
ClinicalTrials.gov

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Pratik Bahekar, MBBS [2]

For patient information, click here.

Overview

Category

US Brand Names

FDA Package Insert

| Indications and Usage | Dosage and Administration | Dosage Forms and Strengths | Contraindications | Warnings and Precautions | Adverse Reactions | Drug Interactions | Use in Specific Populations | Overdosage | Description | Clinical Pharmacology | Nonclinical Toxicology | Clinical Studies | How Supplied/Storage and Handling | Patient Counseling Information | Labels and Packages

Mechanism of Action

[1]

References

  1. ↑ "ISORDIL (ISOSORBIDE DINITRATE) TABLET [BTA PHARMACEUTICALS, INC.]". Retrieved 30 January 2014.
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