isosorbide mononitrate vs dinitrate conversion

cGMP-cGK-I inhibits theinositol-1,4,5-trisphosphate (IP3)-dependent calcium release, decreasing the intracellular calcium. ISDN has a short half-life and is primarily effective clinically by metabolism to the active metabolite isosorbide-5-mononitrate, which has an average half-life of 5 hours. AdultsAt first, 30 or 60 milligrams (mg) once a day. Isosorbide dinitrate is used to prevent chest pain ( angina) in patients with a certain heart condition ( coronary artery disease ). The route of administration for this medicine is oral, but it can be taken under the tongue as well. 5. Adult 2-10 mg/hour, increased if necessary up to 20 mg/hour. Thadani U, Rodgers T. Side effects of using nitrates to treat angina. The most common side-effect is headache. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. Your doctor will be the best person to decide what treatment is best for you. Isosorbide dinitrate conventional tablets, peak: 60 minutes. Isosorbide mononitrate and isosorbide dinitrate - NHS Isosorbide mononitrate differs from isosorbide dinitrate according to the number of nitro groups per molecule. Isosorbide undergoes bioactivation in the endoplasmic reticulum through the cytochrome P450 enzymes to release NO[7], which activates the enzyme soluble guanylyl cyclase in the vascular smooth muscles, thereby increasing the levels of intracellular cGMP and the associated protein kinases such as cGMP- dependent protein kinases(cGK-I). Their those has to be increased sufficiently to be given in oral form in maintenance therapy as these are rapidly degraded by liver with very low . Nitrates in the management of chronic coronary syndrome. Isosorbide 5-Mononitrate | SpringerLink If you have darker skin your gums or the skin around your eyes may turn blue or grey, you take too many isosorbide mononitrate or isosorbide dinitrate tablets or capsules, and you feel unwell, swelling in lower legs, ankles or feet (oedema), you are having breathing difficulties that are new or worse than usual, you get weakness in your arm, or one side of your body or face, difficulty speaking, or loss of coordination these could be signs of a stroke, your mouth (lips, tongue or gums), face or skin start to look blue or grey. Other medicines used to prevent angina attacks are: If you cannot take either of these medicines, you may be given another medicine such as ivabradine, nicorandil or ranolazine. Initially, isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg (1 tablet of BiDil) 3 times daily. endobj In: StatPearls [Internet]. Both direct vasodilatory effects on the coronary bed and drug-induced prevention of episodic coronary artery vasoconstriction increase total coronary blood flow. Isosorbide Mononitrate: Uses, Dosage & Side Effects. Drugs.com. Isosorbide dinitrate | Drugs | BNF | NICE Overview and Key Difference You'll usually take these medicines for a long time, possibly for the rest of your life. 2. Isosorbide mononitrate and dinitrate are both generally safe to take for a long time. Maximum daily dosage of Dilatrate-SR: 160 mg (4 capsules). The following infographic presents thedifference between isosorbide mononitrate and isosorbide dinitrate in tabular form for side by side comparison. Available for Android and iOS devices. If this happens, sit or lie down and put your feet up. Heart failure - Treatment - Hydralazine and Isosorbide Dinitrate The key difference between isosorbide mononitrate and isosorbide dinitrate is that isosorbide mononitrate is primarily used in the management of chronic stable angina, whereas isosorbide dinitrate is recommended for heart failure. Furthermore, there can be some severe effects as well, which include low blood pressure when exposed to PDE5 inhibitors, e.g. In the latter case, glyceryl trinitrate is preferable. 1. Pleiotropic regulation of vascular smooth muscle tone by cyclic GMP-dependent protein kinase. Conversion table Original isosorbide prescription: Convert to: 10 mg twice a day at 8am and 4pm 20 mg twice a day at 8am and 4pm Isosorbide is used to manage anginal pain due to coronary artery disease, and it has approval for use in heart failure. After several days, dosage may be increased to 120 mg (given as single 120-mg tablet or two 60-mg tablets) once daily. Nitrostat (Nitroglycerin) Relieves chest pain. An interdosing interval sufficient to avoid tolerance to Dilatrate-SR extended-release capsules is not known, but it must exceed 18 hours. Nitrates | Prescribing information | Angina | CKS | NICE By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. ChildrenUse and dose must be determined by your doctor. (See Tolerance and Dependence under Cautions.). Headaches can be a sign that the medicine is working, and they might lessen with continued use of the medication. Isosorbide is a medication used to treat and prevent angina pectoris in patients with coronary heart disease. It's important that you keep taking your medicine to keep you well. Madhu is a graduate in Biological Sciences with BSc (Honours) Degree and currently persuing a Masters Degree in Industrial and Environmental Chemistry. Isosorbide dinitrate fixed-combination tablets with hydralazine hydrochloride, peak: 60 minutes. Isosorbide dinitrate and mononitrate are typically given chronically to prevent angina attacks. !W#Lgy How does isosorbide dinitrate work? According to pharmacokinetic data, the bioavailability of this drug is about 25% on average, and its metabolism occurs in the liver. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Treatment of chronic angina pectoris due to coronary artery disease. Along with non-selective beta-blockers (NSBB), it can be used as secondary prophylaxis in preventing recurrent variceal hemorrhage. The venous hypotension and the arterial hypovolemia of isosorbide overdose can be managed clinically by: There is currently no evidence of teratogenicity or carcinogenicity potential of isosorbide.[11]. Boden WE, Finn AV, Patel D, Peacock WF, Thadani U, Zimmerman FH. Long-acting nitrates. The elimination half-life of isosorbide dinitrate is 1 hour, while the elimination half-life of isosorbide mononitrate is 5 to 6 hours. It has high bioavailability and a longer half-life (4-6 hours) than ISDN. Weused pulse pressure as the in vivo haemodynamicindex, andshowedthat the ED50s (doses to reduce pulse pressure by 50%) were 10.2, 18.1, 43.2 and48.6mgkg-1, forL-isoidide mono-nitrate, isosorbide-2-mononitrate, isomannide mono-nitrate and5-ISMN,respectively (only a 5 . Imdur is a vasodilator and Ranexa is an anti-anginal medication. DailyMed - ISOSORBIDE MONONITRATE ER tablet, extended release However, if you have angina you may have a higher risk of having a heart attack or stroke. What Is Difference Between Isosorbide Mononitrate And Dinitrate? The three forms of organic nitrates are described separately . Isosorbide mononitrate is available under the following different brand names: Imdur, Monoket, and ISMO. They work by preventing attacks from happening. Drinking alcohol can increase the effects of isosorbide mononitrate and dinitrate. All rights reserved. Mnzel T, Steven S, Daiber A. Organic nitrates: update on mechanisms underlying vasodilation, tolerance and endothelial dysfunction. Invasive monitoring of central fluid volume is advised in renal failure and congestive heart failure patients. Postural hypotension may occur and may cause dizziness, weakness, and other signs of cerebral ischemia. Careful clinical or hemodynamic monitoring for possible hypotension or tachycardia if used in acute MI or heart failure. Isosorbide mononitrate adalah obat untuk mencegah serangan angina pektoris pada penderita penyakit jantung koroner. Elantan long (EL) is the only long-acting isosorbide mononitrate formulation based on a controlled membrane principle. These are not all the side effects of isosorbide mononitrate and isosorbide dinitrate. Prolonged use of oral nitrates has been associated with the development of tolerance to the hemodynamic and antianginal effects and possibly with cross-tolerance to sublingual nitrates. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Hydralazine and Isosorbide Dinitrate in Heart Failure Do not chew or crush them. Isosorbide mononitrate (ISMN) is the active metabolite of ISDN and is primarily used in the management of chronic stable angina. Isosorbide mononitrate: Generally, food delays the rate but not the extent of absorption (less than 10%) of conventional or extended-release tablets. The immediate-release form (eg, ISMO and Monoket) is typically given in 2 doses daily 7 hours Headache, the most frequent adverse effect, may be severe (persistent or transient) and is perceived as a pulsating, throbbing sensation; frequent early in therapy, usually diminishes rapidly, and may disappear within several days to weeks of continuous therapy. Aim of the study: To investigate the effect of different nitrates on isolated rabbit hearts and aortic strips and the mechanism responsible for nitrate tolerance, using nitroglycerine (NTG), isosorbide dinitrate (ISDN), 5-mononitrate (5MN) and 2-mononitrate (2MN). Some people need to take 2 or more medicines. They differ from each other according to their applications and properties. Answers. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. Talk to your doctor if you're not sure it's safe for you to exercise. Isosorbide dinitrate-hydralazine combination therapy in African Americans with heart failure. Note: 0.84 mL alcohol per 100 mL solution For prevention of angina. TGA eBS - Product and Consumer Medicine Information 4 0 obj Aspirin or acetaminophen may relieve. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. Imdur vs. Isordil Prescription Treatment for Chest Pain - RxList Isosorbide dinitrate (ISDN) is 1,4:3,6-dianhydro-D-glucitol 2,5 dinitrate, an organic nitrate whose structural formula is . Administring normal saline. Isosorbide mononitrate. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Talk to your doctor if you're taking a combined hormonal contraceptive. These may make your angina or heart failure worse. But it is less preferred compared to beta-blockers or calcium channel blockers. Development of a Combination Product. Do nitrates differ? - Wiley (adsbygoogle = window.adsbygoogle || []).push({}); Copyright 2010-2018 Difference Between. Isosorbide mononitrate - Wikipedia Parker JD, Parker JO. The approximate onset and duration of action of various dosage forms of isosorbide dinitrate (ISDN) and isosorbide mononitrate (ISMN) are as follows: Onset and duration of action following intrabuccal administration are probably similar to those after sublingual administration of isosorbide dinitrate. Isosorbide dinitrate or mononitrate can be used alone or in combination as either second-line or third-line therapy in patients previously treated with a -blocker. Isosorbide dinitrate is contraindicated in patients with shock or marked low blood pressure. Dhi Ubu Each Isosorbide mononitrate extended-release tablet, for oral administration contains 30 mg, 60 mg or 120 mg of ISMN. Transient flushing may occur with the nitrates, and inhalation of amyl nitrite commonly causes cutaneous flushing of the head, neck, and clavicular area. Importance of informing patients of other important precautionary information. Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN., African-American Heart Failure Trial Investigators. Although a . We can use this medication to both treat and prevent heart-related chest pain. Isosorbide-5-mononitrate is rapidly absorbed and peak plasma levels occur approx. [14] In contrast, isosorbide mononitrate, an active metabolite of isosorbide dinitrate,does not undergo the first-pass effect, and its bioavailability is 100 percent after oral administration.[15][16]. Nitrate therapy for stable angina pectoris. Isosorbide-5-mononitrate must not be used in cases of: hypersensitivity to isosorbide-5-mononitrate (the active substance), other nitrate compounds or to any of the excipients acute circulatory failure (shock, circulatory collapse) cardiogenic shock, unless a sufficiently high left-ventricular end-diastolic pressure is Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. No significant differences in PP decline were demonstrated between the two groups (5.28 vs 7.49 mmHg in the active group and placebo, respectively, p = 0.79). Sublingual isosorbide dinitrate and nitroglycerin are the two compounds used to treat acute angina. Review the appropriate monitoring necessary with isosorbide. Nitrates | Treatment summaries | BNF | NICE Tablets may be taken with or without food, and should be swallowed whole and not chewed. Some of the patient education strategies include educating regarding the following: Home care workers can help elderly patients prone to developing orthostatic hypotension with Home safety measures. Isosorbide Mononitrate: Fungsi Obat, Dosis, dll. Hello Sehat The organic nitrates are vasodilators, active on both arteries and veins. Conversion table It will take a few days to prevent angina symptoms. Long-acting isosorbide mononitrate - PubMed Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses. Importance of warning all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potentially severe and life-threatening hemodynamic consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation. VA class: CV250 It is not suitable to take to treat an angina attack - you should always carry with you a short-acting nitrate, such as glyceryl trinitrate (GTN), for if you get angina pain. Suggested schedules: Usually, at 7 a.m., 12 p.m., and 5 p.m. in chronic stable angina or at 7 a.m. and 12 p.m. in less severely symptomatic angina in order to allow for a nitrate-free interval of 1014 hours. It is as safe as other forms of exercise with similar levels of effort. Selective PDE inhibitors can potentiate the hypotensive effects of organic nitrates and nitrites, possibly resulting in potentially life-threatening hypotension and/or hemodynamic compromise. Isosorbide dinitrate sublingual, peak: 1015 minutes. But Its maximal effect is seen in venous capacitance vessels. [18] They are as follows: PDE inhibitors such as tadalafil and sildenafil work by inhibiting the phosphodiesterase (PDE) enzyme, which is involved in breaking down the cGMP. The elimination half-life of isosorbide dinitrate is 1 hour, while the elimination half-life of isosorbide mononitrate is 5 to 6 hours. mononitrate, isomannide mononitrate, isosorbide-2-mononitrate, and 5-ISMN. <> May titrate dosage to a maximum tolerated dosage not to exceed 2 tablets (a total of 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride) 3 times daily. Isosorbide mononitrate vs dinitrate | HealthTap Online Doctor Intermediate: Release is Isosorbide Dinitrate while mono nitrate is extended.Immediate release is nitro stat. (See Selective Phosphodiesterase (PDE) Inhibitors under Cautions.). Patients who fail to respond to nitroglycerin lingual or sublingual: 2.55 mg of isosorbide dinitrate. Treatment effect. Tight, light-resistant containers at 25C; may be exposed to 1530C. This might make you feel dizzy or faint. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. [11] It decreases systemic vascular resistance (afterload) by dilating the peripheral arterioles. Importance of warning all patients receiving organic nitrates or nitrites about the potential interaction between the drugs and selective PDE inhibitors, even if they currently are not receiving the drugs, since there is substantial potential for patients to receive the drugs from another clinician, from a friend, with little or no clinical intervention (e.g., via the Internet), or illicitly. Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. This study describes the relationship between nitroglycerin, isosorbide dinitrate, sodium nitroprusside, and carbonic anhydrase I, as well as the involvement of this carbonic anhydrase I in vasodilation. % Isosorbide dinitrate is effective by mouth for the prophylaxis and treatment of angina; although the effect is slower in onset, it may persist for several hours. Isosorbide mononitrate (Monoket) is good for a specific type of chest pain (called angina), but it can cause headaches or dizziness after you take it. Therefore, the concomitant use of isosorbide with riociguat (a soluble guanylate cyclase stimulator) will cause an increased level of cGMP resulting inlife-threatening hypotension.[24]. By intravenous infusion. Contact dermatitis occurs in up to 40% of patients using transdermal Isosorbide mononitrate slow-release tablets or capsules: Isosorbide dinitrate slow-release tablets: Isosorbide dinitrate immediate release tablets: Taking too much isosorbide mononitrate or dinitrate may cause your blood pressure to fall too low, making you feel sick, faint and dizzy. If you take other medicines that lower blood pressure with isosorbide mononitrate and dinitrate, it can sometimes lower your blood pressure too much. There can be some side effects of using this medication, which include headache, low blood pressure, blurry vision, and skin flushing. PI & CMI Trade Names and Active Ingredients containing. Summary Isosorbide Mononitrate vs Isosorbide Dinitrate. (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be . In addition, each tablet contains the . One manufacturer of isosorbide mononitrate states that dosage should be selected with caution, usually initiating therapy at the low end of the range, although age, renal, hepatic, and cardiovascular dysfunction do not appear to have a significant effect on drug clearance. Nitrates - GlobalRPH Imdur (IMD) is a sustained-release isosorbide 5-mononitrate preparation for the treatment of chronic stable angina pectoris. Cardiology 24 years experience. Nurses and general practitioners should ensure that isosorbide therapy is not an option for patients with erectile dysfunction by taking phosphodiesterase (PDE) inhibitors. (dinitrate conventional tablets) two to three times daily. [2] It can be used both to treat and to prevent heart-related chest pain; however, it is generally less preferred than beta blockers or calcium channel blockers. What is Isosorbide Mononitrate Side effects often improve as your body gets used to the medicine. Divakaran S, Loscalzo J. . This medication belongs to a class of drugs known as nitrates . Caution if used in nursing women. Not known whether geriatric patients respond differently than younger patients. Lethal dose LD50 of isosorbide has not been a topic of sufficient research in the human population. Learn how we can help. [26]Tolerance may develop within as little as 12 to 24 hours,with a subsequent reduction in the clinical effects of isosorbide; this necessitates the need for a drug-free interval of at least 10 to 12 hours a day. Nitrates as an integral part of optimal medical therapy and cardiac rehabilitation for stable angina: review of current concepts and therapeutics. Because of this decrease in the heart's workload, myocardial oxygen demand becomes reduced. It has high . These include: Some people with angina worry that having sex will trigger an angina attack, but the risk of this happening is low. If you stop taking isosorbide mononitrate or isosorbide dinitrate, your symptoms may get worse. In the V-HeFT I and II trials, isosorbide dinitrate was dosed 20 mg four times a day for 2 weeks, then 40 mg four times a day; In the A-HeFT trial, isosorbide dinitrate was initially dosed 20 mg three times a day, then increased to 40 mg three times a day if tolerated; May take without regard to food [17] Isosorbide does not need dose adjustment in patients with renal and hepatic dysfunction. Conventional measures in the management of angina pectoris are aimed at reducing the frequency, duration, and severity of attacks, and include coronary risk reduction (e.g., discontinuance of smoking, weight control, antilipemic strategies), rest, avoidance of precipitating circumstances (e.g., eating heavy meals, getting emotionally upset, performing strenuous exercise, exposure to cold air) and, if possible, treatment of the underlying cause. On the basis of V-HeFT I and II results, an application was filed with the Food and Drug Administration for a methods patent on the H-ISDN combination in 1987, 17 which would give marketing rights for the combination specifically for heart failure. Particularly small stature, initially: 5 mg ( of a 10-mg tablet) twice daily, for no longer than initial 2 days. Changing positions slowly can help lessen dizziness. Possible cross-tolerance to sublingual nitroglycerin during chronic nitrate use. Inal ME, Egz AM. The principal pharmacological action of isosorbide mononitrate is relaxation of vascular smooth However, if you are pregnant or trying for a baby then you should be seen as soon as possible by a pregnancy specialist (obstetrician) and a heart specialist (cardiologist) so your heart and medicine can be reviewed. PI. ever had an allergic reaction to isosorbide mononitrate or isosorbide dinitrate or any other medicine, any other heart problems, including a recent heart attack, any recent brain or head injuries or problems, 10mg, taken twice a day, up to a maximum dose of 120mg, split into smaller doses, 25mg to 60mg, up to a maximum dose of 120mg, taken once a day, 40mg, taken once or twice a day, up to a maximum dose of 60mg to 80mg, taken 2 or 3 times a day, 10mg to 20mg, taken 2 to 3 times a day, or 40mg, taken twice a day, up to a maximum dose of 120mg daily, split into smaller doses, 40mg to 160mg, taken daily, up to a maximum dose of 240mg a day, split into divided doses, your mouth (lips, tongue or gums), face or skin start to look blue or grey. The key difference between isosorbide mononitrate and isosorbide dinitrate is that isosorbide mononitrate is primarily used in the management of chronic stable angina, whereas isosorbide dinitrate is recommended for heart failure.. Isosorbide mononitrate and isosorbide dinitrate are important medications for some heart diseases. May need to adjust schedule for those arising earlier than 7 a.m. since early morning angina is common. The elimination half-life of isosorbide dinitrate is about 1 hour, and the excretion occurs through the kidney. Your heart muscles need oxygen in your blood to work. Isosorbide Dinitrate - Uses, Side Effects, and More - WebMD Multiple health care professionals such as cardiologists, general practitioners, nurses, pharmacists, home care workers, and dieticians can work together to overcome these challenges of isosorbide therapy. May cause a burning or tingling sensation when administered sublingually. Advise patients to take nitrates as directed, particularly since tolerance can occur. Abshagen UW. They may need to change your dose. Target: 40 mg 3 times/day. The most common brand names of this medication are Monoket and Imdur. Rapid titration (over 35 days) may be possible; however, slower titration may be needed due to adverse effects. Administer extended-release tablets with adequate amounts of fluid (e.g., 120 mL) on arising in the morning. Your email address will not be published. Talk to your pharmacist if you need a painkiller stronger than paracetamol. Visit Yellow Card for further information, non-steroidal anti-inflammatory medicines (NSAIDs), no more than 14 units of alcohol each week, HealthUnlocked: isosorbide dinitrate forum, HealthUnlocked: isosorbide mononitrate forum, About isosorbide mononitrate and isosorbide dinitrate, Who can and cannot take isosorbide mononitrate and isosorbide dinitrate, How and when to take isosorbide mononitrate and isosorbide dinitrate, How to cope with side effects of isosorbide mononitrate and isosorbide dinitrate, Common questions about isosorbide mononitrate and isosorbide dinitrate. [15]When a longer duration of action is needed, clinicians can use a slow-release oral preparation that contains an amount of drug to withstand the hepatic metabolism and maintain the required therapeutic level. Extended-release tablets can be administered as whole or halved tablets, but swallow intact and do not chew or crush. Heart failure - Treatment - Hydralazine and Isosorbide Dinitrate Isosorbide dinitrate also comes as an injection or drip (infusion), which is given in hospital. x\[o~`kYH]r M 0-:/n77nnN,v.V"mYf/2[7bf?x>}>\wG }Nx'XT^FVw_fo ~;Hfz^@mlgz]3GD6'lKi~6A-,Bw Lt"i'1Y}=7Og b-yb@Y=lY(v -l`'c#EqxXhb MANO{65j5H$~$2J-;oHDI~ IY~wr_x Isosorbide belongs to the nitrate group of medications that acts by releasing nitric oxide (N0), thereby causing vasodilation. Less frequent administration of isosorbide dinitrate may reduce the development of tolerance to the drugs antianginal effects. Molecular formula: C6H8N2O8C6H9NO6 Nitrate dependence is possible (documented in daily industrial exposures); withdrawal manifestations (e.g., ischemic symptoms, MI, sudden death) can occur. Two groups of coronary patients and a group of rabbits underwent treatment with the above-mentioned vasodilating drugs. Therecommended drug-free intervals for preventing the development of tolerance for oral sustained-release isosorbide dinitrate are as follows[27]: The patients should understand the possibility of developing anginal episodes during the drug-free interval. Isosorbide mononitrate has one nirate group and isosorbide dinatrate has 2 nitro groups. Isosorbide mononitrate: Uses, Interactions, Mechanism of - DrugBank <> ~}xp%0Vg^r3WT_a-~qvQD]dvo{,Z@${ssJC j(2GW`_? Isosorbide Dinitrate (ISDN) is an intermediate acting nitrate approved for prevention of angina pectoris. Prophylactic management in situations likely to provoke angina attacks in patients who fail to respond to sublingual nitroglycerin: place 2.55 mg of isosorbide dinitrate under the tongue about 15 minutes prior to engaging in such activities. The key difference between isosorbide mononitrate and isosorbide dinitrate is that isosorbide mononitrate is primarily used in the management of chronic stable angina, whereas isosorbide dinitrate is recommended for heart failure. Tarkin JM, Kaski JC. Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. CAS number: 87-33-2. Isosorbide mononitrate and dinitrate can make some people feel dizzy, sleepy or faint. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. The oral lethal dose LD50 of isosorbide is 2010 mg/kg in rats and 1771 mg/kg in mice. 30% of the dose is available for immediate release and the remaining 70% is gradually released over time.

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