Drug reference

Isosorbide dinitrate

Nitrate · Antianginal

NitrateAntianginal

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

9 major

incl. contraindicated

PREGNANCY

—

not curated

Top interactionssee all 9 →

SildenafilContraindicatedTextbook-citedKDT 7e · p950
TadalafilContraindicatedTextbook-citedKDT 7e · p950
AvanafilSevereDatabaseDDInter
NicorandilSevereDatabase

Mechanism

Isosorbide dinitrate is an organic nitrate that must be metabolized (reduced) to produce gaseous nitric oxide (NO). NO then activates guanylyl cyclase, increasing the cellular level of cyclic GMP. This leads to the activation of protein kinase G and modulation of phosphodiesterases. In smooth muscle, the net result is reduced phosphorylation of myosin light chain, causing vasodilation.

Indications

Ischaemic pain (e.g., in unstable angina, NSTEMI, acute coronary syndromes)Heart failurecombination with hydralazine provides survival benefit in chronic heart failure

Dosing

Adult: intravenous for ischaemic pain if sublingual glyceryl trinitrate is ineffective

Pharmacokinetics

Bioavailability

PO: 22 ± 14%; SL: 45 ± 16%; PC: 33 ± 17%

Protein binding

28 ± 12%

Metabolism

Metabolized (reduced) to produce nitric oxide (NO).

Excretion

<1%

Drug interactions

Sildenafil

Contraindicated

Textbook-cited

Precipitous and potentially fatal fall in blood pressure; myocardial ischemia.

Concurrent use is absolutely contraindicated

Source: KDT 7e · p950

Tadalafil

Contraindicated

Textbook-cited

Precipitous and potentially fatal fall in blood pressure; myocardial ischemia

Concurrent use is absolutely contraindicated

Source: KDT 7e · p950

Avanafil

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Nicorandil

Severe

Database

Additive hypotensive effects, potentially leading to severe hypotension, dizziness, syncope, and reflex tachycardia.

Avoid concomitant use if possible. If co-administration is necessary, monitor blood pressure closely and consider reducing the dose of one or both agents. Educate the patient about symptoms of hypotension.

Nitrous Acid

Severe

Database

Clinical effect not specified

Source: DDInter

Prilocaine

Severe

Database

Clinical effect not specified

Source: DDInter

Riociguat

Severe