Isosorbide Dinitrate Oral: Dosing and Precautions
Isosorbide dinitrate guidance for angina prophylaxis, chronic heart failure, and acute angina rescue, with nitrate safety precautions.
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Source reviewed
August 2021
Guide category
Oral drugs
Safety boundary
Prescription medicine information for clinician-guided use.
Kenza Health Hub presents this medicine page as structured health education. Check dose, route, interactions, pregnancy or breast-feeding considerations, and local protocol with a qualified clinician or pharmacist. Read our medical editorial policy.
Therapeutic action
Vasodilator, antianginal.
Indications
- Prophylaxis and treatment of acute angina.
- Treatment of left-sided or global chronic heart failure in patients with intolerance to ACE inhibitors.
- Adjunctive therapy in acute heart failure (acute pulmonary oedema).
Forms and strengths
- 5 mg sublingual tablet.
Dose
Gradually increase the dose until effective. Do not stop treatment abruptly.
Short-term prophylaxis of acute angina
- Adult: 5 to 10 mg sublingually taken 10 minutes before a precipitating event such as physical exertion or stress.
Long-term prophylaxis of acute angina and treatment of left-sided or global chronic heart failure
- Adult: 5 to 40 mg orally 2 to 3 times daily.
Treatment of acute angina
- Adult: 5 to 10 mg sublingually, to be repeated after 10 minutes if necessary.
Adjunctive therapy in acute heart failure (acute pulmonary oedema)
- Adult: 5 mg sublingually, to be repeated after 10 minutes if necessary.
- The objective is to lower systolic pressure to 120 to 150 mmHg and diastolic pressure to under 110 mmHg.
Duration
According to clinical response.
Contra-indications, adverse effects, precautions
- Do not administer to patients with obstructive cardiomyopathy, hypotension, shock, severe anaemia, intracranial hypertension, or neurologic injury.
- May cause orthostatic hypotension, headache, nausea, flushing, haemolytic anaemia in patients with G6PD deficiency, and severe hypotension in overdose.
- Avoid combination or use the lowest effective dose in patients taking another nitrate derivative, a vasodilator, a diuretic, or an antihypertensive drug, and in older patients.
- Do not combine with sildenafil or other drugs used for erectile dysfunction.
- Pregnancy: not recommended.
- Breast-feeding: not recommended.
Source
MSF Essential drugs practical guidelines (January 2026)
This page combines source-derived medicine reference sections with Kenza editorial context, while leaving out the Storage and Remarks sections from the source batch.
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