Isosorbide Dinitrate 10mg Oral Tabs

Isosorbide dinitrate is an organic nitrate that acts as a vasodilator. It is metabolized to nitric oxide (NO), which activates guanylate cyclase, leading to an increase in cyclic guanosine monophosphate (cGMP) in smooth muscle cells. This results in dephosphorylation of myosin light chains, causing relaxation of vascular smooth muscle. The primary effect is venodilation, which reduces preload (venous return to the heart), thereby decreasing myocardial oxygen demand. It also causes arterial dilation, reducing afterload and improving coronary blood flow, especially in epicardial arteries.

Urgent Side Effects: Seek Medical Attention Immediately

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical help right away:

Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Severe dizziness or fainting
Abnormal heartbeat (fast or slow)

Other Possible Side Effects

Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or persist, contact your doctor for guidance:

Headaches: You may experience headaches when starting this medication, but they often improve over time. Do not adjust your dosage without consulting your doctor. Instead, discuss ways to manage this side effect with your doctor.

Reporting Side Effects

This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
Certain health conditions, including:
+ Heart failure (weak heart)
+ Recent heart attack
If you are currently taking any of the following medications:
+ Avanafil
+ Riociguat
+ Sildenafil
+ Tadalafil
+ Vardenafil

Please note that this is not an exhaustive list of all potential interactions. To ensure your safety, it is crucial to discuss all of your:

Prescription and over-the-counter (OTC) medications
Natural products
Vitamins
* Health problems

with your doctor and pharmacist. They will help you determine whether it is safe to take this medication in combination with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you are using this drug to manage chest pain, be aware that it will not provide immediate relief during an attack. Instead, it is designed to help prevent or reduce the frequency of chest pain episodes. If you experience new or worsening chest pain or pressure, seek emergency medical attention immediately.

To ensure your safety, avoid driving and other activities that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution when navigating stairs. Monitor your blood pressure and heart rate as directed by your doctor.

Before consuming alcohol, discuss the potential risks and benefits with your doctor. Long-term, uninterrupted use of this medication may lead to reduced effectiveness, a phenomenon known as tolerance. To avoid this, your doctor may recommend a daily "nitrate-free" period. If you notice that the medication is no longer working as well as it should, consult your doctor; do not exceed the prescribed dosage.

If you are pregnant, planning to become pregnant, or breastfeeding, inform your doctor to discuss the potential benefits and risks to both you and your baby. This will enable you to make an informed decision about your treatment.

• Phosphodiesterase-5 (PDE5) inhibitors (e.g., sildenafil, tadalafil, vardenafil, avanafil) - concurrent use can cause severe hypotension and cardiovascular collapse.
• Riociguat (soluble guanylate cyclase stimulator) - concurrent use can cause severe hypotension.

• Alcohol - may enhance hypotensive effects.
• Antihypertensives (e.g., beta-blockers, calcium channel blockers, ACE inhibitors, diuretics) - additive hypotensive effects.
• Ergot alkaloids (e.g., ergotamine) - nitrates may reduce the anti-migraine effect of ergot alkaloids and may cause severe vasoconstriction.

• Aspirin - may increase isosorbide dinitrate levels and enhance its effects.
• Dihydroergotamine - risk of severe hypotension.

• Headache (common, often transient)
• Dizziness/Lightheadedness (especially upon standing)
• Flushing
• Nausea/Vomiting
• Weakness
• Blurred vision
• Syncope

Category C. Use only if the potential benefit justifies the potential risk to the fetus. Animal studies have shown adverse effects, but there are no adequate and well-controlled studies in pregnant women.

L3 (Moderately Safe). It is not known whether isosorbide dinitrate or its metabolites are excreted in human milk. Use with caution. Monitor infant for signs of hypotension or methemoglobinemia.

Safety and efficacy have not been established in pediatric patients. Use is generally not recommended.

Elderly patients may be more susceptible to the hypotensive effects of nitrates. Start with lower doses and titrate slowly. Monitor blood pressure closely.

• To prevent nitrate tolerance, an 18-hour nitrate-free interval is crucial. This often means taking the last dose of the day earlier (e.g., 5 PM) and skipping a nighttime dose.
• Headache is a very common side effect, especially at the beginning of therapy. It often diminishes with continued use. Patients can be advised to take an analgesic (e.g., acetaminophen) for headache.
• Educate patients about the importance of avoiding PDE5 inhibitors (e.g., Viagra, Cialis) due to the risk of severe, life-threatening hypotension.
• Isosorbide dinitrate is for prophylaxis of angina, not for acute angina attacks (sublingual nitroglycerin is preferred for acute relief).
• Patients should be advised to sit or lie down if they experience dizziness or lightheadedness.

• Other organic nitrates (e.g., isosorbide mononitrate, nitroglycerin)
• Beta-blockers (e.g., metoprolol, carvedilol)
• Calcium channel blockers (e.g., amlodipine, diltiazem, verapamil)
• Ranolazine
• Ivabradine (for specific indications)

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more details. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide information about the medication taken, the amount, and the time it happened.