1 May 2026Oral drugsSource update: August 2021
Isosorbide dinitrate oral
Isosorbide dinitrate guidance for angina prophylaxis, chronic heart failure, and acute angina rescue, with nitrate safety precautions.
Prescription under medical supervision
This guide page is for structured reference only and does not replace a clinician, pharmacist, or emergency review. Dose choice, route choice, interactions, and safety decisions still need professional judgment.
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 reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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