What is the use of Isosorbide?

From the Guidelines

Isosorbide is used to treat heart failure, specifically in patients with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal medical therapy, particularly in African Americans.

Uses of Isosorbide

• Isosorbide dinitrate is used in combination with hydralazine to reduce morbidity and mortality in patients with HFrEF, especially in African Americans who remain symptomatic despite concomitant use of ACE inhibitors (or ARBs), beta blockers, and mineralocorticoid receptor antagonists (MRAs) 1.
• The combination of hydralazine and isosorbide dinitrate can be useful in patients who cannot be given an ACE inhibitor or ARB due to drug intolerance, hypotension, or renal insufficiency 1.
• Isosorbide dinitrate may also be used to decrease symptoms of dyspnea at night and during exercise, and to improve exercise tolerance in patients with persistent limitations despite optimization of other therapies 1.

Important Considerations

• The use of isosorbide dinitrate and hydralazine should be considered as a therapeutic option in patients who are intolerant of ACE inhibitors or ARBs, but compliance with this combination has generally been poor due to the large number of tablets required and the high incidence of adverse reactions 1.
• Adverse effects of isosorbide dinitrate include headaches, dizziness, and gastrointestinal complaints, and a "nitrate-free interval" of at least 10 hours may be necessary to minimize the development of nitrate tolerance 1.

From the FDA Drug Label

Isordil (isosorbide dinitrate) Titradose tablets are indicated for the prevention of angina pectoris due to coronary artery disease. The use of Isosorbide is for the prevention of angina pectoris due to coronary artery disease 2.

• The drug is not useful for aborting an acute anginal episode.
• It is used to prevent angina attacks, but not to treat them once they occur.

From the Research

Uses of Isosorbide

• Isosorbide is used to treat angina pectoris and prevent symptomatic and asymptomatic myocardial ischemia 3
• It is also used in the treatment of acute myocardial infarction, where it can help prevent post-infarction angina 4
• Isosorbide has a vasodilator effect, which makes it useful in the treatment of heart failure 5
• It can be administered via various routes, including sublingual, oral, intravenous, and transdermal 5

Benefits of Isosorbide

• Isosorbide can improve exercise capacity in patients with coronary artery disease 6
• It can reduce the frequency of angina episodes and improve symptoms of myocardial ischemia 3, 4
• Isosorbide-5-mononitrate, a form of isosorbide, has been shown to be cost-effective compared to isosorbide dinitrate in patients with coronary heart disease 7

Administration and Dosage

• Isosorbide can be administered in various dosages, including 5-10 mg and 10-30 mg orally 6
• The dosage and administration of isosorbide should be tailored to the individual patient's needs, with a daily low-nitrate interval to prevent tolerance development 3, 5
• A single dose of a sustained-release preparation or 2-3 doses of a short-acting preparation can be prescribed via the oral route 5