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Isosorbide dinitrate is available as a generic medication. [1] [5] A long-acting form exists. [1] In 2022, isosorbide was the 119th most commonly prescribed medication in the United States, with more than 5 million prescriptions. [6] [7]
Nitrates mainly differ in speed and duration of their action. Glyceryl trinitrate acts fast and short (10 to 30 minutes), while most other nitrates have a slower onset of action, but are effective for up to six hours. Molsidomine, as has been mentioned, not only acts slowly but also differs from the nitrates in exhibiting no tolerance. [2]
Nicorandil is an anti-angina medication that has the dual properties of a nitrate and ATP-sensitive K + channel opener. [7] In humans, the nitrate action of nicorandil dilates the large coronary arteries at low plasma concentrations. [7]
Isosorbide mononitrate, sold under many brand names, is a medication used for heart-related chest pain , heart failure and esophageal spasms. [2] It can be used both to treat and to prevent heart-related chest pain; however, it is generally less preferred than beta blockers or calcium channel blockers . [ 2 ]
By nitration of isosorbide with concentrated nitric acid, 2,5-isosorbide dinitrate (ISDN) can be obtained. 2,5-isosorbide dinitrate is suitable (just like its major metabolite 5-isosorbide mononitrate, ISMN [6]) for the treatment of angina pectoris due to its vasodilator effect. [7]
It is a combination of hydralazine hydrochloride (an arteriolar vasodilator) and isosorbide dinitrate (a nitrate vasodilator). [ 1 ] [ 2 ] The US Food and Drug Administration (FDA) approved medication to treat congestive heart failure in specifically self-identified Black patients.
In the medical field, nitrate-derived organic esters, such as glyceryl trinitrate, isosorbide dinitrate, and isosorbide mononitrate, are used in the prophylaxis and management of acute coronary syndrome, myocardial infarction, acute pulmonary oedema. [10] This class of drug, to which amyl nitrite also belongs, is known as nitrovasodilators.
The most common adverse effects are headache, which occurs in 10–25% of patients, and low blood pressure. Side effects occurring in fewer than 1% of patients include dizziness, nausea , reflex tachycardia (fast heartbeat), hypersensitivity reactions, as well as thrombocytopenia (low blood platelet count) in rare cases.
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