Why use isosorbide

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Authors and Disclosures
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Author(s)
Laura S. Lehman, PharmD| Pharmacist, Carroll Hospital Center, Westminster, Maryland

Disclosure: Laura S. Lehman, PharmD, has disclosed no relevant financial relationships. |
From Medscape Pharmacists > Ask theExperts
Why Use Isosorbide Dinitrate vs Isosorbide Mononitrate?
Laura S. Lehman, PharmD
Posted: 08/23/2010
Question:
What is the difference or advantage of using isosorbide dinitrate over isosorbidemononitrate?
| Response from Laura S. Lehman, PharmD
Pharmacist, Carroll Hospital Center, Westminster, Maryland |
Isosorbide is a nitrate vasodilator available in various oral forms, whichinclude inexpensive generic versions. Isosorbide dinitrate (ISDN) is an intermediate-acting nitrate approved for prevention of angina pectoris.[1] It is also used in conjunction with hydralazine intreating congestive heart failure, particularly in African Americans who have inadequate response to optimal medical therapy.[2] The US Food and Drug Administration (FDA)-approved formulation for heartfailure is the fixed combination of ISDN/hydralazine tablet (BiDil®). Isosorbide dinitrate is also available in immediate-release (eg, Isordil®) and extended-release (eg, Dilatrate-SR®) forms. Thebioavailability of ISDN varies widely, and it undergoes significant first-pass metabolism. The half-life of ISDN is about 1 hour. When ISDN is administered in 3 to 4 doses daily, nitrate tolerance candevelop, rendering the agent less efficacious.[1]
Isosorbide mononitrate (ISMN) is the active metabolite of ISDN and is primarily used in the management of chronic stable angina. It is not FDA-approved fortreating heart failure. It has high bioavailability and a longer half-life (4-6 hours) than ISDN. The immediate-release form (eg, ISMO® and Monoket®) is typically given in 2 doses daily 7 hours...