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Isosorbide dinitrate oral

Updated 2 Feb 2023 | Longer acting nitrates


Standard release formulations of isosorbide dinitrate

Drugs List

  • isosorbide dinitrate 10mg tablets
  • isosorbide dinitrate 20mg tablets
  • Therapeutic Indications


    Congestive heart failure (adjunct)
    Prophylaxis of angina pectoris
    Treatment of angina pectoris



    30 to 120 mg daily in divided doses according to individual requirements. Dosage should be gradually increased to minimise nitrate headache and/or tolerance.

    Congestive Cardiac Failure
    40 to 160 mg daily in divided doses according to individual requirements. The optimum dose is best determined by continuous haemodynamic monitoring. The use of isosorbide dinitrate tablets in severe congestive cardiac failure should be regarded as an adjunctive therapy to more conventional treatment.

    The maximum daily dose should not exceed 240 mg in divided doses.

    Enhancement of the dose and / or a change in the dose interval may lead to reduction or even loss of effect.


    (See Dosage; Adult)
    However, dosage may need to be reduced where there is impairment of renal or hepatic function.


    Children under 18 years
    Low cardiac filling pressures
    Aortic stenosis
    Cardiac tamponade
    Cerebrovascular haemorrhage
    Circulatory failure
    Constrictive pericarditis
    Head trauma
    Hypertrophic obstructive cardiomyopathy
    Low filling pressure - if treating acute myocardial infarction
    Mitral stenosis
    Narrow angle glaucoma
    Raised intracranial pressure
    Severe anaemia
    Toxic pulmonary oedema

    Precautions and Warnings

    Predisposition to narrow angle glaucoma
    G6PD deficiency
    Glucose-galactose malabsorption syndrome
    Lactose intolerance
    Recent myocardial infarction
    Severe hepatic impairment
    Severe renal impairment

    Advise ability to drive/operate machinery may be affected by side effects
    Contains lactose
    Assess patient's tolerance to treatment
    Cross tolerance to other nitrates may develop
    Tolerance may occur with prolonged use of large doses
    Avoid abrupt withdrawal
    Maintain treatment at the lowest effective dose
    Advise patient to moderate alcohol intake during treatment
    Hypotensive effect enhanced by alcohol
    Advise patient not to use for relief of acute attacks

    Pregnancy and Lactation


    Isosorbide dinitrate should only be used in pregnancy if it is considered essential.

    At the time of writing there is limited published experience concerning the use of isosorbide dinitrate during human pregnancy, however there are no reports of adverse effects occurring. The molecular weight (about 236) is low enough that passage to the foetus should be expected. Dose related toxicity has been observed in rabbits at doses 35 and 150 times the maximum recommended human doses. Studies have shown that isosorbide dinitrate may be effective in reversing the effects of endothelial cell dysfunction which is observed in preeclampsia, but further studies are required (Briggs, 2011). Schaefer (2007) concludes that nitrates may be used in pregnancy for the appropriate indications.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use isosorbide dinitrate with caution in breastfeeding.

    At the time of writing there is limited published experience concerning the use of isosorbide dinitrate during breastfeeding, however there are no reports of adverse effects occurring. The molecular weight (about 236) is low enough that passage into the breast milk should be expected, but effects on the nursing infant are unknown. Schaefer (2007) concludes that the short half life and usually brief use, argue against a toxic risk for the breastfed infant.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Aggravation of angina
    Allergic skin reactions
    Cardiac arrhythmias
    Cerebral ischaemia
    Cutaneous vasodilation
    Decrease in blood pressure
    Exfoliative dermatitis
    Glaucoma (closed angle)
    Myocardial hypoxia
    Peripheral oedema
    Pituitary apoplexy
    Postural hypotension
    Reflex tachycardia
    Stevens-Johnson syndrome
    Tolerance to this drug and cross tolerance to other nitrates


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: September 2013

    Reference Sources

    British National Formulary, 66th Edition (September 2013 - March 2014) Pharmaceutical Press, London.

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Summary of Product Characteristics: Isosorbide Dinitrate tablets BP 10mg. Actavis UK Ltd. Revised June 2009.
    Summary of Product Characteristics: Isosorbide Dinitrate tablets BP 20mg. Actavis UK Ltd. Revised June 2009.

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