Isordil: Effective Angina Prevention and Relief
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Isordil (isosorbide dinitrate) is a well-established nitrate vasodilator prescribed for the prevention and treatment of angina pectoris. It works by relaxing and widening blood vessels, allowing for increased blood flow and oxygen supply to the heart muscle, thereby reducing cardiac workload. This medication is a cornerstone in the management of coronary artery disease, offering both prophylactic and acute therapeutic benefits under proper medical supervision. Its efficacy and safety profile have been demonstrated through decades of clinical use, making it a trusted option for cardiovascular care.
Features
- Active ingredient: Isosorbide dinitrate
- Available in sublingual, chewable, and oral tablet formulations
- Rapid onset of action for sublingual administration (2–5 minutes)
- Extended duration with oral formulations for prophylactic use
- Standardized dosing for predictable pharmacokinetics
- Manufactured under strict pharmaceutical quality controls
Benefits
- Reduces frequency and severity of angina attacks
- Decreases myocardial oxygen demand through venous and arterial dilation
- Provides rapid symptomatic relief during acute episodes
- Supports improved exercise tolerance and functional capacity
- Helps manage chronic ischemic heart disease
- Contributes to overall cardiac risk management when used as directed
Common use
Isordil is primarily indicated for the prophylaxis and treatment of angina pectoris. It is commonly prescribed for patients with stable exertional angina, unstable angina, and variant (Prinzmetal’s) angina. The sublingual formulation is typically used for acute relief of angina attacks, while oral formulations are employed for long-term prevention. Off-label uses may include adjunctive therapy in congestive heart failure and perioperative blood pressure control in specific cardiac procedures, though these applications require specialist evaluation.
Dosage and direction
Dosage must be individualized based on patient response and tolerance. For acute angina relief: place one sublingual tablet (2.5–5 mg) under the tongue at the first sign of an attack, may repeat every 5–10 minutes up to three doses within 15–30 minutes. For prophylaxis: oral tablets typically range from 5–40 mg administered 2–4 times daily, with at least a 14-hour nitrate-free interval to prevent tolerance development. Chewable tablets (5–10 mg) may be used every 2–3 hours as needed. Always follow prescribing physician’s instructions exactly.
Precautions
Patients should avoid sudden discontinuation due to risk of rebound angina. Use with caution in patients with hypotension, hypovolemia, or inferior wall myocardial infarction. May cause severe hypotension with concomitant phosphodiesterase inhibitors. Orthostatic hypotension may occur, particularly in elderly patients. Tolerance develops with continuous exposure; a nitrate-free interval is essential for maintained efficacy. Caution advised in patients with hypertrophic cardiomyopathy due to potential exacerbation of outflow obstruction.
Contraindications
Absolute contraindications include hypersensitivity to nitrates, concurrent use with phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil), and severe anemia. Not recommended in patients with increased intracranial pressure, severe hypotension (systolic <90 mmHg), or cardiogenic shock. Contraindicated in patients with marked bradycardia or tachycardia. Should not be used in patients with acute myocardial infarction with low filling pressures.
Possible side effect
Common side effects include headache (often dose-related), dizziness, orthostatic hypotension, and flushing. Less frequently reported are nausea, vomiting, weakness, and palpitations. Rare but serious adverse effects include syncope, methemoglobinemia (with high doses), and paradoxical angina. Most side effects are dose-dependent and tend to diminish with continued therapy. Headache typically responds to analgesic therapy and often decreases in severity over time.
Drug interaction
Significant interactions occur with phosphodiesterase-5 inhibitors (risk of severe hypotension), other vasodilators (additive hypotensive effects), and alcohol (potentiated vasodilation). Calcium channel blockers and beta-blockers may have additive effects on blood pressure and heart rate. Concurrent use with riociguat is contraindicated. Aspirin may increase nitrate bioavailability. Antihypertensive agents may require dose adjustment when initiating nitrate therapy.
Missed dose
If a scheduled prophylactic dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double doses to make up for a missed dose. For sublingual tablets used as needed for acute attacks, no specific missed dose protocol applies. Maintain regular dosing schedule for chronic prophylaxis to ensure consistent therapeutic effects and prevent rebound phenomena.
Overdose
Symptoms include severe hypotension, throbbing headache, dizziness, palpitations, visual disturbances, nausea, vomiting, syncope, and methemoglobinemia (characterized by cyanosis despite adequate oxygenation). Management involves placing patient in Trendelenburg position, administering intravenous fluids, and considering alpha-adrenergic agonists if necessary. Methylene blue may be required for methemoglobinemia. Hemodialysis is not effective due to high protein binding.
Storage
Store at controlled room temperature (15–30°C/59–86°F) in original container. Protect from light, moisture, and heat. Keep sublingual tablets in original glass container with cotton removed to prevent absorption. Do not transfer to other containers. Keep tightly closed when not in use. Do not use if tablets discolored or show signs of deterioration. Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Isordil is a prescription medication that should be used only under the supervision of a qualified healthcare provider. Individual response to therapy may vary. Always consult with a physician for proper diagnosis, treatment recommendations, and monitoring. Do not initiate or discontinue therapy without medical guidance.
Reviews
Clinical studies demonstrate Isordil’s efficacy in reducing angina frequency by 50-70% in appropriate patient populations. Physicians report reliable performance in both acute and prophylactic settings when used according to established protocols. Patients note improved quality of life and exercise capacity, though many report initial headache as a limiting factor. Long-term safety data support its continued use in comprehensive cardiac care programs. Overall satisfaction rates remain high among appropriately selected patients under medical supervision.