Isosorbide Dinitrate

ATC code

C01DA08

Therapeutic class

Vasodilator used in cardiac diseases · Organic nitrate

Forms

oral tablet, sublingual tablet, extended-release capsule

Brand names

ISO-LACER (ES) · Isordil (US) · Dilatrate-SR (US)

Overall confidence

medium

Regulatory sources consulted

Treatment and prophylaxis of angina pectoris.
Treatment of chronic congestive heart failure (in combination with other drugs, typically hydralazine).
Treatment of diffuse esophageal spasm.

Concomitant use of phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil) due to risk of severe hypotension.
Severe hypotension (systolic blood pressure < 90 mmHg) or cardiogenic shock.
Severe anemia.
Hypersensitivity to nitrates.

Major warning · Risk of orthostatic hypotension, especially in the elderly or volume-depleted patients. May cause syncope. — AEMPS CIMA
Drug tolerance may develop, decreasing its effect. A daily nitrate-free interval is required. — AEMPS CIMA

HighSildenafilG04BE03
Mechanism: Synergistic increase in cGMP (NO donor + PDE5 inhibition), resulting in severe systemic vasodilation and life-threatening hypotension.
Recommendation: Concomitant use is contraindicated. Actively ask the patient about the use of these drugs.
AEMPS CIMA FT 49679
HighRiociguatC02KX05
Mechanism: Potentiation of the hypotensive effect. Both drugs increase the cGMP pathway, one by NO donation and the other by stimulating soluble guanylate cyclase.
Recommendation: Concomitant use is contraindicated.
AEMPS CIMA FT 49679

headache · dizziness · hypotension · reflex tachycardia · flushing

methemoglobinemia · syncope · paradoxical angina · exfoliative dermatitis

FDA category: C

Pregnancy: Use only if the benefit outweighs the potential risk to the fetus. Lactation: It is unknown if excreted in human milk; use with caution.