From the Guidelines
Isordil (isosorbide dinitrate) can be given to heart failure patients, specifically those with reduced ejection fraction, under a doctor's prescription and supervision, often in combination with hydralazine, as recommended by the 2017 ACC/AHA/HFSA guideline update 1. The standard dosage for heart failure is usually 20-40 mg taken orally three times daily, as part of a fixed-dose combination with hydralazine, with a maximum dose of 40 mg isosorbide dinitrate/75 mg hydralazine TID 1. This medication works by relaxing blood vessels, which reduces the workload on the heart and improves blood flow. However, Isordil can cause side effects like headaches, dizziness, and low blood pressure. It's particularly important to monitor blood pressure when starting this medication. Patients should take it on an empty stomach, avoid alcohol while using it, and should not stop taking it suddenly without medical advice. This medication is not appropriate for all heart failure patients, particularly those with certain types of valve disease or those taking medications for erectile dysfunction. Always consult with a healthcare provider before administering any medication to a heart failure patient, considering the latest guidelines and evidence-based recommendations, such as those from the American College of Cardiology and the American Heart Association 1. Some key considerations for heart failure management include the use of ACE inhibitors, ARBs, beta blockers, and aldosterone antagonists, as well as the importance of monitoring blood pressure and adjusting medication regimens accordingly 1. In addition, the 2017 ACC/AHA/HFSA guideline update provides detailed recommendations for the management of heart failure with reduced ejection fraction, including the use of isosorbide dinitrate and hydralazine in certain patient populations 1. Key points to consider when prescribing Isordil for heart failure patients include:
- Monitoring blood pressure and adjusting the medication regimen as needed
- Avoiding the use of Isordil in patients with certain types of valve disease or those taking medications for erectile dysfunction
- Considering the use of Isordil in combination with hydralazine for patients with reduced ejection fraction
- Following the recommended dosage and administration guidelines for Isordil
- Consulting with a healthcare provider before administering any medication to a heart failure patient.
From the FDA Drug Label
The benefits of immediate-release oral isosorbide dinitrate in patients with acute myocardial infarction or congestive heart failure have not been established. If one elects to use isosorbide dinitrate in these conditions, careful clinical or hemodynamic monitoring must be used to avoid the hazards of hypotension and tachycardia
- Key Points:
- The benefits of isosorbide dinitrate in heart failure patients have not been established.
- Use in heart failure requires careful monitoring to avoid hypotension and tachycardia.
- This formulation is not recommended in these settings due to difficulties in terminating its effects rapidly. Isordil (isosorbide dinitrate) can be given to a heart failure patient, but with caution and careful clinical or hemodynamic monitoring to avoid the hazards of hypotension and tachycardia 2.
From the Research
Heart Failure Treatment
The treatment of heart failure involves a combination of pharmacologic therapies aimed at improving survival, reducing hospitalizations, and alleviating symptoms.
- The mainstay therapies for heart failure with reduced systolic function include angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, with diuretics used to control fluid balance 3.
- In patients who cannot tolerate ACE inhibitors, alternative therapies such as the combination of hydralazine and isosorbide dinitrate may be considered 3, 4.
Use of Isordil in Heart Failure
Isordil, also known as isosorbide dinitrate, is a vasodilator that can be used in the treatment of heart failure.
- Studies have shown that isosorbide dinitrate can provide symptomatic relief in patients with severe heart failure by reducing pulmonary arterial end-diastolic pressure and improving cardiac output 5.
- The combination of hydralazine and isosorbide dinitrate has been shown to be effective in reducing morbidity and mortality in patients with heart failure with reduced ejection fraction, particularly in African-American patients who are symptomatic despite optimal neurohumoral therapy 6, 4, 7.
Considerations for Use
When considering the use of Isordil in a heart failure patient, it is essential to take into account the patient's individual characteristics, such as their ability to tolerate ACE inhibitors or beta-blockers.
- The fixed-dose combination of isosorbide dinitrate and hydralazine has been shown to be effective in patients with or without ACE inhibitors or beta-blockers, although beta-blockers may provide additional benefit in certain subgroups of patients 7.