isosorbide mononitrate vs dinitrate conversion

Isosorbide mononitrate: Generally, food delays the rate but not the extent of absorption (less than 10%) of conventional or extended-release tablets. After oral administration, isosorbide mononitrate EL has a quick onset of action (30 minutes) and effects are evident for . Both direct vasodilatory effects on the coronary bed and drug-induced prevention of episodic coronary artery vasoconstriction increase total coronary blood flow. Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use. Take the first dose in the morning right after you . The principal pharmacological action of isosorbide mononitrate is relaxation of vascular smooth In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to isosorbide mononitrate and isosorbide dinitrate. Some people need to take 2 or more medicines. This activity describes the indications, action, and contraindications for isosorbide as a valuable agent in treating angina pectoris due to coronary artery disease, heart failure with reduced ejection fraction, and achalasia. Maximum: 80 mg 3 times/day. (See Cautions.). Less frequent administration of isosorbide dinitrate may reduce the development of tolerance to the drugs antianginal effects. The elimination half-life of isosorbide dinitrate is 1 hour, while the elimination half-life of isosorbide mononitrate is 5 to 6 hours. sildenafil. @media (max-width: 1171px) { .sidead300 { margin-left: -20px; } } How does isosorbide dinitrate work? Treasure Island (FL): StatPearls Publishing; 2022 Jan-. If your heart needs to work harder, during exercise for example, it needs increased blood flow to get more oxygen. 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. This medicine is not suitable for some people. 1. % Isosorbide mononitrate differs from isosorbide dinitrate according to the number of nitro groups per molecule. Imdur and Ranexa belong to different drug classes. Though methemoglobinemia is a rare complication, patients more susceptible to developing methemoglobinemia require close monitoring for signs and symptoms. 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. Because of their hemodynamic profile, particularly beneficial in patients with left ventricular systolic dysfunction or heart failure. 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 Dinitrate - Uses, Side Effects, and More - WebMD Isosorbide Dinitrate VS Isosorbide Mononitrate. Tell your doctor or pharmacist if you have: Take isosorbide mononitrate and dinitrate exactly as your doctor or pharmacist tells you to. Importance of consulting clinician if headache continues with repeated dosing. Christiansen I, Iversen HK, Olesen J. Headache characteristics during the development of tolerance to nitrates: pathophysiological implications. Benefits in acute MI and heart failure not established. [Principles and rules of the use of nitrates] - PubMed Lincoln TM, Komalavilas P, Cornwell TL. Nitrates | Treatment summaries | BNF | NICE Relieves chest pain. Parker JD, Parker JO. Compare Isosorbide Dinitrate vs Nitroglycerin - Iodine.com Standard-release nitrate preparations: use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimize development of nitrate tolerance. Daiber A, Mnzel T. Organic Nitrate Therapy, Nitrate Tolerance, and Nitrate-Induced Endothelial Dysfunction: Emphasis on Redox Biology and Oxidative Stress. Not known whether geriatric patients respond differently than younger patients. Pharmacokinetics and pharmacodynamics of isosorbide dinitrate. Bortolotti M, Coccia G, Brunelli F, Sarti P, Mazza M, Bagnato F, Barbara L. Isosorbide dinitrate or nifedipine: which is preferable in the medical therapy of achalasia? Isosorbide mononitrate and dinitrate are types of heart medicine called nitrates. Heart failure - Treatment - Hydralazine and Isosorbide Dinitrate Conventional tablets: Approximately 100%. Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. PDF (isosorbide mononitrate, USP) Rx Only - Food and Drug Administration If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. Selective PDE inhibitors can potentiate the hypotensive effects of organic nitrates and nitrites, possibly resulting in potentially life-threatening hypotension and/or hemodynamic compromise. Let your provider know if they are excessive. ;6YXZp2k>!'Z)IfFW`VG@Y!b /r980t ~pE Isosorbide Mononitrate Tablets 10 mg - Summary of Product - medicines Describe the potential adverse effects patients may experience when using isosorbide. Isosorbide mononitrate and isosorbide dinitrate are important medications for some heart diseases. 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. 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). By intravenous infusion. This activity will highlight the mechanism of action, adverse event profile, off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions pertinent to the health care team members in managing patients with angina pectoris due to coronary artery disease and related conditions. Isomonit | definition of Isomonit by Medical dictionary Isosorbide mononitrate: Uses, Interactions, Mechanism of - DrugBank e5;O"]rQR8ku:mw/CYux:s8ofW`KMb`! The Role of Nitroglycerin and Other Nitrogen Oxides in Cardiovascular Therapeutics. Isosorbide dinitrate is good for chest pain, but you have to be able to stick to your dosing schedule or it won't work as well. This is called glyceryl trinitrate, or GTN. Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. If your heart failure is directly related to drinking alcohol, you may be advised to stop completely. For example, if you are taking standard tablets twice a day, they may tell you to take 1 dose in the morning at 8am and the second dose in the afternoon at 2pm (leaving a gap of 6 hours between your first and . Isosorbide Mononitrate in Heart Failure with Preserved Ejection What is the Difference Between Isosorbide Mononitrate and Isosorbide Importance of informing patients of other important precautionary information. Below is a conversion table to enable using this preparation in place of standard release isosorbide mononitrate and modified release (M/R) preparations which are not going to be kept. Z L0y+"Z=A]*=_/Kw&FEa"O,KqKl]s-:G{. <> Talk to your doctor if you are having problems with your sex life. Concomitant use of isosorbide with PDE inhibitors will cause increased cGMP, resulting in life-threatening hypotension. [17] Isosorbide does not need dose adjustment in patients with renal and hepatic dysfunction. Tell your doctor if this happens to you. No more than 3 doses in a 15- to 30-minute period. Or 30 to 60 mg (mononitrate extended-release tablets) once daily. Nitrate dependence is possible (documented in daily industrial exposures); withdrawal manifestations (e.g., ischemic symptoms, MI, sudden death) can occur. Access free multiple choice questions on this topic. The principal pharmacological action of ISMN and all organic nitrates in general is relaxation of vascular . Peripheral venous resistance is decreased via a selective action on venous capacitance vessels and results in venous pooling of blood and decreased venous return to the heart. Isosorbide dinitrate or mononitrate is used for the acute relief of angina pectoris, for prophylactic management in situations likely to provoke angina attacks, and for long-term prophylactic management of angina pectoris. Talk to your doctor or pharmacist if these side effects bother you or last more than a few days: Serious side effects after taking isosorbide mononitrate and dinitrate are rare. The trade name of this drug is Isordil. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Posology. However, monitoring is recommended in: Close monitoring of blood pressure and heart rate in the above patients is recommended to avoid severe hypotension and bradycardia. PDF STANDARD vs. MODIFIED RELEASE ISOSORBIDE MONONITRATE There is no clear evidence that isosorbide mononitrate or dinitrate affects fertility in men or women. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. 2. This might make you feel dizzy or faint. Will I need to stop taking it before surgery or before tests? ASK DIS: Isosorbide Dinitrate VS Isosorbide Mononitrate - Blogger This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) This is because it can lower your blood pressure too much when combined with some anaesthetics. 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. DailyMed - ISOSORBIDE MONONITRATE ER tablet, extended release Created for people with ongoing healthcare needs but benefits everyone. [11] It decreases systemic vascular resistance (afterload) by dilating the peripheral arterioles. Isosorbide Monograph for Professionals - Drugs.com 2 0 obj Avoid long-acting dosage forms in the early management of acute MI or heart failure since the effects are difficult to terminate rapidly should excessive hypotension or tachycardia occur. Prophylaxis and treatment of angina for isosorbide dinitrate By mouth using immediate-release medicines. Warn 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. 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 . If you are taking isosorbide mononitrate or dinitrate and are bothered by side effects, speak to your doctor. Paradoxical bradycardia and angina exacerbation may accompany hypotension. The manufacturer of the fixed combination of isosorbide dinitrate and hydralazine hydrochloride states that dosage should be selected with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. The exact mechanism of action in the relief of angina pectoris has not been fully elucidated. Initially, isosorbide dinitrate conventional tablets (e.g., Isordil Titradose) 520 mg administered 23 times daily, followed by maintenance dosage of 1040 mg administered 23 times daily (some patients may require higher dosages). Isosorbide mononitrate and dinitrate can be taken in pregnancy. Available for Android and iOS devices. If this happens, sit or lie down and put your feet up. If you take isosorbide mononitrate or dinitrate 2 or 3 times a day, your doctor or pharmacist will explain how to space out your doses. 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. Invasive monitoring of central fluid volume is advised in renal failure and congestive heart failure patients. you have taken too much isosorbide mononitrate or dinitrate and: If you need to go to A&E, do not drive yourself get someone else to drive you or call an ambulance. Terms of Use and Privacy Policy: Legal. Isosorbide Article - StatPearls Cardiology 24 years experience. ISDN works directly on the vascular smooth muscle in an identical manner to the natural endothelium derived relaxing factor, nitric oxide. Isosorbide mononitrate. Known hypersensitivity to isosorbide or any ingredient in the respective formulation. Monomax XL 60 mg Prolonged Release Tablets - medicines Isosorbide dinitrate structure By Vaccinationist Own work (Public Domain) via Commons Wikimedia. May need to adjust schedule for those arising earlier than 7 a.m. since early morning angina is common. For oral dosage form (tablets): Adults20 milligrams (mg) two times a day. "[~ If you are trying to get pregnant, talk to your doctor. Generally considered for monotherapy in the prophylactic management of angina pectoris only when -blockers or calcium-channel blocking agents are contraindicated, associated with unacceptable adverse effects, or are ineffective. Isosorbide mononitrate (Monoket): Basics, Side Effects & Reviews - GoodRx This increases the blood supply to your heart, which gets more oxygen to your heart muscles and this reduces chest pain. Do not use extended-release isosorbide dinitrate preparations or any isosorbide mononitrate preparation to abort an acute anginal episode or for acute relief of angina or in the prophylactic management in situations likely to provoke angina attacks; onset is not sufficiently rapid. [7], Isosorbide helps alleviate the symptoms of angina byincreasing the myocardial blood flow and decreasing the myocardial oxygen demand. Madhu is a graduate in Biological Sciences with BSc (Honours) Degree and currently persuing a Masters Degree in Industrial and Environmental Chemistry. Your doctor will be the best person to decide what treatment is best for you. They are similar medicines that work in the same way, but the doses are different so you'll need to take the type that you're prescribed. Isosorbide mononitrate - UpToDate The tablets and capsules usually start to work within 1 hour. Isosorbide mononitrate vs dinitrate | HealthTap Online Doctor Isosorbide dinitrate conventional tablets, peak: 60 minutes. The venodilation results in peripheral pooling of blood and arteriolar dilation, lowering systemic vascular resistance (afterload) and lowering blood pressure. In the latter case, glyceryl trinitrate is preferable. 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. After therapeutic doses, cardiac output may increase transiently and then decrease. Nitrostat (Nitroglycerin) Relieves chest pain. Identify the mechanism of action of isosorbide. FDA Approved Indications for Isosorbide Dinitrate, Non-FDA Approved Indications for Isosorbide Dinitrate, FDA Approved Indications for Isosorbide Mononitrate, Isosorbide is a nitrate that exerts its pharmacologic effect by releasing nitric oxide (NO), an endothelium-derived relaxing factor (EDRF).NO is endogenously produced in the endothelium to dilate the blood vessels. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name, 20 mg with Hydralazine Hydrochloride 37.5 mg. AHFS DI Essentials. Congestive heart failure: Oral: Initial: 10 mg 3 times/day. When isosorbide dinitrate is used in fixed combination with hydralazine, consider the cautions, precautions, and contraindications associated with hydralazine. Abshagen UW. Porje initiated the research on isosorbide in Stockholm, and the drug was marketed in Sweden in 1946. But Its maximal effect is seen in venous capacitance vessels. The cGMP activates the myosin light chain phosphatase (MLCP), causing dephosphorylation of the myosin light chain. 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. Titrate dosages to levels similar to those recommended for the fixed-combination preparation and administer both drugs at least 3 times daily. Boden WE, Finn AV, Patel D, Peacock WF, Thadani U, Zimmerman FH. (See Selective Phosphodiesterase (PDE) Inhibitors under Cautions.). They may be able to change your dose or prescribe a different medicine instead. Take any leftover tablets or capsules, and the packet or leaflet with you. This medication is commercially available in two forms: as an oral tablet both in extended-release and slow release. Isosorbide Mononitrate vs Isosorbide Dinitratein Tabular Form Method of administration. Isosorbide dinitrate and mononitrate are typically given chronically to prevent angina attacks. Copyright 2023, Selected Revisions February 7, 2017. Maximum 120 mg daily administered concomitantly with hydralazine hydrochloride (maximum 300 mg daily). Maximum daily dosage of Dilatrate-SR: 160 mg (4 capsules). 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. This medicine is particularly used in heart failure due to the ability of systolic dysfunction in combination with hydralazine. Imdur vs. Ranexa Prescription Treatment for Chest Pain - RxList Organic Nitrates - LiverTox - NCBI Bookshelf No specific dosage recommendations for hepatic impairment. Isosorbide mononitrate is in the class of drugs called nitrates that are used for treating and preventing angina.Other nitrates include nitroglycerin (Nitrostat, NitroQuick, Nitrolingual, Nitro-Dur and others) and isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron).Nitrates are vasodilators (dilators of blood vessels). In addition to vascular smooth muscle, nitrates and nitrites relax bronchial, biliary (including the gallbladder, biliary ducts, and sphincter of Oddi), GI (including the esophagus), ureteral, and uterine smooth muscle; nitrates relax all smooth muscle irrespective of autonomic innervation and are functional antagonists of norepinephrine, acetylcholine, and histamine. Isosorbide mononitrate - Wikipedia Isosorbide. [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]. It is not FDA-approved for treating heart failure. How much isosorbide mononitrate or dinitrate you take depends on your symptoms, the brand of medicine and the type of tablets or capsules you are taking. Isosorbide is used to manage anginal pain due to coronary artery disease, and it has approval for use in heart failure. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patient's requirements and response; use the smallest effective dosage. However, do not take medicines for erection problems if you are taking isosorbide mononitrate or dinitrate. Summary Isosorbide Mononitrate vs Isosorbide Dinitrate. 4. Hydralazine and Isosorbide Dinitrate in Heart Failure 1 hour following oral dosing. It's important to stay active if you have angina or heart failure. Controlled medication release is achieved using the Durules principle of insoluble matrix embedding.Data from randomised double-blind trials show that IMD 60mg once daily (the most widely studied dosage) has significant antianginal and anti-ischaemic effects compared . ChildrenUse and dose must be determined by your doctor. Patients with right ventricular infarction are preload sensitive. Isosorbide Mononitrate (ISMN), an organic nitrate and the major biologically active metabolite of isosorbide dinitrate (ISDN), is a vasodilator with effects on both arteries and veins. It has high . Talk to your pharmacist if you need a painkiller stronger than paracetamol. Sublingual isosorbide dinitrate and nitroglycerin are the two compounds used to treat acute angina. Isosorbide mononitrate and dinitrate will not stop your contraception working, including emergency contraception. As the active metabolite of isosorbide dinitrate, ISMN does not require first-pass metabolism for activation and its longer half-life allows for twice-daily dosing. It usually happens because your arteries have become hardened and narrowed. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 1. Apart from limiting alcohol, you can eat and drink normally while you are taking isosorbide mononitrate or dinitrate. A total of 20% of patients in the isosorbide dinitrate-oxytocin group recorded headache, and no cases of uterine tachysystole, haemorrhage or coagulopathy were recorded. -Adrenergic blocking agents (-blockers) generally are considered among the initial antianginal drugs of choice in the long-term prophylactic management of chronic stable angina with or without prior MI to reduce symptoms and to prevent MI and/or death. The symptoms of isosorbide overdose may arise from its vasodilating property causing profound systemic hypotension, heart block with bradycardia, syncope, nausea, vomiting, increased intracranial tension (probably along with persistent throbbing headache, fever, confusion), diaphoresis, dizziness, and palpitations. Chemical name: d-Glucitol-1,4:3,6-dianhydrodinitrate The possibility of developing orthostatic hypotension in elderly patients, The possibility of developing severe hypotension when combined with Phosphodiesterase(PDE) inhibitors in male patients, The development of tolerance during chronic isosorbide therapy and drug-free intervals, The possibility of developing anginal pain during drug-free intervals. This medication belongs to a class of drugs known as nitrates . Isosorbide dinitrate is used to prevent chest pain ( angina) in patients with a certain heart condition ( coronary artery disease ). Prescription only. These include: Some people with angina worry that having sex will trigger an angina attack, but the risk of this happening is low. UpToDate For a full list, see the leaflet inside your medicines packet. Or 5 to 20 mg (mononitrate conventional tablets) b.i.d. Readily (and almost completely) absorbed from the GI tract and oral mucosa, but considerable variations in the bioavailability (1090%) secondary to extensive first-pass metabolism in the liver. Lethal dose LD50 of isosorbide has not been a topic of sufficient research in the human population. Treatment effect. Your doctor may tell you to leave a gap of 4 to 12 hours a day (usually when you are sleeping) where you do not take the tablets or capsules. 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. Oral nitrates are available in two forms: isosorbide dinitrate (ISDN) and isosorbide-5-mononitrate (ISMN). 2 x 60mg tablets taken in the morning). Isosorbide dinitrate comes as standard tablets and slow-release tablets. Chewable tablet: 5-10 mg every 2-3 hours. Isosorbide mononitrate (Monoket) can cause headaches, dizziness, or lightheadedness. The effect of food on the bioavailability of isosorbide dinitrate when administered in fixed combination with hydralazine hydrochloride is not known. They are also given with other medicines to treat heart failure including left ventricular failure. Required fields are marked *. Tight, light-resistant containers at 25C; may be exposed to 1530C. 2. and whose molecular weight is 236.14. Adults: Usual adult dose is one isosorbide mononitrate XL 60 mg tablet per day (taken in the morning).If necessary, the dosage may be increased to 120 mg once daily (i.e. The patient should be sitting immediately after sublingual or intrabuccal administration. Although many clinicians do not gradually reduce the dosage when discontinuance of oral nitrates is planned, it appears prudent that dosage be gradually reduced (e.g., over a period of about 1-2 weeks) to avoid withdrawal . If you take other medicines that lower blood pressure with isosorbide mononitrate and dinitrate, it can sometimes lower your blood pressure too much. ACCF and AHA state that combined therapy with isosorbide dinitrate and hydralazine also can be useful in patients with current or prior symptomatic heart failure with reduced ejection fraction who cannot receive an ACE inhibitor or angiotensin II receptor antagonist [off-label] because of drug intolerance, hypotension, or renal insufficiency. Other adverse effects can be due to the reflex activity of the sympathetic nervous system due to vasodilation. Each dilatrate Nitrates - Knowledge @ AMBOSS [8][9], The decreased intracellular calcium inhibits the myosin light chain kinase(MLCK). Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. Do not chew or crush them. ), which permits others to distribute the work, provided that the article is not altered or used commercially. Figure 01: The Chemical Structure of Isosorbide Mononitrate. Particularly small stature, maintenance: Increased to at least 10 mg twice daily by the second or third day. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patients requirements and response; use the smallest effective dosage. Drug class: Nitrates and Nitrites Readily absorbed from the GI tract; does not undergo first-pass hepatic metabolism. Headaches can be a sign that the medicine is working, and they might lessen with continued use of the medication. 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. The most common side effects of isosorbide dinitrate include headache, lightheadedness when standing, and blurred vision. The usage of epinephrine and other vasoconstrictors is generally not recommended. Target: 40 mg 3 times/day. [1] This opinion changed after a few years, and now it gained worldwide acceptance. Isosorbide Nitrates, Nitroglycerin, and Sodium Nitroprusside Induce Do nitrates differ? - Wiley Tarkin JM, Kaski JC. Isosorbide mononitrate (ISMN) is the active metabolite of ISDN and is primarily used in the management of chronic stable angina. Learn how we can help. Thadani U, Rodgers T. Side effects of using nitrates to treat angina. After oral administration, isosorbide dinitrate undergoes an extensive first-pass effect in the liver, reducing the oral bioavailability to 20 percent. 4 0 obj Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. Distribution into human body tissues and fluids has not been fully characterized. The oral lethal dose LD50 of isosorbide is 2010 mg/kg in rats and 1771 mg/kg in mice. Isosorbide dinitrate (Isordil) is good for a specific type of chest pain (called angina), but it can cause headaches after you take it.

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