Concomitant use of isosorbide with PDE inhibitors will cause increased cGMP, resulting in life-threatening hypotension. For example, if you are taking standard tablets twice a day, they may tell you to take 1 dose in the morning at 8am and the second dose in the afternoon at 2pm (leaving a gap of 6 hours between your first and second dose). Maximum: 80 mg 3 times/day. It is in the nitrate class of drugs. daily and increasing to 40 mg three times daily as necessary, given at 8 AM, 1 PM, and 6 PM), isosorbide mononitrate (starting at 30 mg/day in the morning and increasing to 120 mg/day as necessary), or a transdermal. Isosorbide mononitrate is the major active metabolite of isosorbide dinitrate (ISDN), and most of the clinical activity of the dinitrate is attributable to the mononitrate. Weused pulse pressure as the in vivo haemodynamicindex, andshowedthat the ED50s (doses to reduce pulse pressure by 50%) were 10.2, 18.1, 43.2 and48.6mgkg-1, forL-isoidide mono-nitrate, isosorbide-2-mononitrate, isomannide mono-nitrate and5-ISMN,respectively (only a 5 . This is called a "nitrate low" period and is needed to make sure your medicine works properly. Angina is chest pain that happens when not enough blood gets to the muscles of the heart. Long-acting isosorbide mononitrate 2-3 times anginal isosorbide mononitrate first-pass liver 100% bioavailability. The challenges of isosorbide therapy are drug interactions, adverse effects, and the development of tolerance during chronic isosorbide therapy. Isosorbide-5-mononitrate is completely bioavailable after oral doses and is not subjected to pre-systemic elimination processes.Isosorbide-5-mononitrate is eliminated from the plasma with half-life of about 5.1 hours. Multiple health care professionals such as cardiologists, general practitioners, nurses, pharmacists, home care workers, and dieticians can work together to overcome these challenges of isosorbide therapy. Some people need to take 2 or more medicines. The elimination half-life of isosorbide dinitrate is about 1 hour, and the excretion occurs through the kidney. In addition to other medications given for congestive heart failure, isosorbide dinitrate is useful in treating angina. They are used to prevent angina symptoms (chest pain), they do not work to treat a current angina attack. Isosorbide Mononitrate (ISMN), an organic nitrate and the major biologically active metabolite of isosorbide dinitrate (ISDN), is a vasodilator with effects on both arteries and veins. Isosorbide therapy in angina and heart failure requires an interprofessional team approach to achieve optimum results. You'll usually take these medicines for a long time, possibly for the rest of your life. Manufacturers of selective PDE inhibitors (e.g., sildenafil, tadalafil, vardenafil) state that the drugs are contraindicated in patients receiving organic nitrates or nitrites in any form (e.g., orally, sublingually, transmucosally, parenterally), given regularly or intermittently, or nitric oxide donors since severe, potentially fatal hypotensive episodes can occur. Chronic isosorbide use without drug-free intervals may cause poor symptom control and endothelial dysfunction due to the release of excessive free radicals.[26]. @media (max-width: 1171px) { .sidead300 { margin-left: -20px; } } Other medicines used to prevent angina attacks are: If you cannot take either of these medicines, you may be given another medicine such as ivabradine, nicorandil or ranolazine. [Updated 2022 Jul 3]. No more than 3 doses in a 15- to 30-minute period. These include: Some people with angina worry that having sex will trigger an angina attack, but the risk of this happening is low. ISDN has a short half-life and is primarily effective clinically by metabolism to the active metabolite isosorbide-5-mononitrate, which has an average half-life of 5 hours. However, monitoring is recommended in: Close monitoring of blood pressure and heart rate in the above patients is recommended to avoid severe hypotension and bradycardia. However, if you have angina you may have a higher risk of having a heart attack or stroke. Your doctor may advise you to stop taking isosorbide mononitrate or dinitrate before surgery. Extended-release tablets: Approximately 7780%. Changing positions slowly can help lessen dizziness. In addition to vascular smooth muscle, nitrates and nitrites relax bronchial, biliary (including the gallbladder, biliary ducts, and sphincter of Oddi), GI (including the esophagus), ureteral, and uterine smooth muscle; nitrates relax all smooth muscle irrespective of autonomic innervation and are functional antagonists of norepinephrine, acetylcholine, and histamine. Adults: 5 to 40 mg P.O. Bortolotti M, Coccia G, Brunelli F, Sarti P, Mazza M, Bagnato F, Barbara L. Isosorbide dinitrate or nifedipine: which is preferable in the medical therapy of achalasia? [2] It is taken by mouth. Isosorbide dinitrate is contraindicated in patients with shock or marked low blood pressure. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patient's requirements and response; use the smallest effective dosage. They are similar medicines that work in the same way, but the doses are different so you'll need to take the type that you're prescribed. Roman S, Kahrilas PJ. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. <> Prophylactic management in situations likely to provoke angina attacks in patients who fail to respond to sublingual nitroglycerin: place 2.55 mg of isosorbide dinitrate under the tongue about 15 minutes prior to engaging in such activities. If relief is not attained after a single dose during an acute attack, may give additional doses at 5- to 10-minute intervals; no more than 3 doses should be given in a 15- to 30-minute period. Extended-release tablets can be administered as whole or halved tablets, but swallow intact and do not chew or crush. This medicine is not suitable for some people. If this happens to you, do not drive, ride a bike or use tools or operate machinery until you feel better. To reduce your risk of problems like these, it may help to: Page last reviewed: 1 July 2021 After therapeutic doses, cardiac output may increase transiently and then decrease. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Moreover, isosorbide mononitrate has a bioavailability of about 95% while isosorbide dinitrate has a bioavailability of about 25%. In contrast, isosorbide mononitrate, an active metabolite of isosorbide dinitrate, does not undergo the first-pass effect, and its bioavailability is 100 percent after oral administration. Identify the mechanism of action of isosorbide. [7], Isosorbide helps alleviate the symptoms of angina byincreasing the myocardial blood flow and decreasing the myocardial oxygen demand. Plasma concentrations and urinary excretion of isosorbide dinitrate and its metabolites in the dog. Isosorbide dinitrate (isordil ) Angina prophylaxis: 5 to 40 mg orally four times daily or 40 mg (sustained release) orally every 8 to 12 hours. Prolonged use of oral nitrates has been associated with the development of tolerance to the hemodynamic and antianginal effects and possibly with cross-tolerance to sublingual nitrates. Orang awam lebih mengenalnya dengan penyakit angin . Showing results for nitrates-in-the-. Thadani U, Rodgers T. Side effects of using nitrates to treat angina. This study describes the relationship between nitroglycerin, isosorbide dinitrate, sodium nitroprusside, and carbonic anhydrase I, as well as the involvement of this carbonic anhydrase I in vasodilation. Thadani U, Whitsett T. Relationship of pharmacokinetic and pharmacodynamic properties of the organic nitrates. Take any leftover tablets or capsules, and the packet or leaflet with you. Kondisi ini disebabkan karena penyempitan atau penyumbatan pembuluh darah dalam tubuh. Isosorbide dinitrate is used to prevent chest pain ( angina) in patients with a certain heart condition ( coronary artery disease ). Isosorbide mononitrate is a medicine important in treating heart-related chest pain, heart failure, and oesophagal spasms. The exact mechanism of action in the relief of angina pectoris has not been fully elucidated. Isosorbide mononitrate and dinitrate belong to a group of medicines called nitrates. Isosorbide dinitrate sublingual, peak: 1015 minutes. What is Isosorbide Mononitrate Your email address will not be published. The effects of isosorbide dinitrate on methemoglobin reductase enzyme activity and antioxidant states. However, do not take medicines for erection problems if you are taking isosorbide mononitrate or dinitrate. Management of spastic disorders of the esophagus. May cause a burning or tingling sensation when administered sublingually. After several days, dosage may be increased to 120 mg (given as single 120-mg tablet or two 60-mg tablets) once daily. Angina and heart failure is a warning sign that you are at risk of serious problems such as heart attacks and strokes. Isosorbide mononitrate vs dinitrate dose conversion Isosorbide mononitrate is usedto treat chest pain (angina) in adults and children above six years of age. Isosorbide dinitrate and mononitrate are typically given chronically to prevent angina attacks. (dinitrate conventional tablets) two to three times daily. 2 x 60mg tablets taken in the morning). Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use. The most common side effects are headaches and feeling dizzy, weak or tired. There can be some side effects of using this medication, which include headache, low blood pressure, blurry vision, and skin flushing. Isosorbide mononitrate or dinitrate is not likely to affect your sex life. Fung HL. Vasodilator Therapy: Nitrates and Nicorandil. Active Ingredient (s) APO- Isosorbide Mononitrate. Access free multiple choice questions on this topic. This activity describes the indications, action, and contraindications for isosorbide as a valuable agent in treating angina pectoris due to coronary artery disease, heart failure with reduced ejection fraction, and achalasia. Inal ME, Egz AM. Or 30 to 60 mg (mononitrate extended-release tablets) once daily. Echols MR, Yancy CW. You can help reduce your risk of problems like these by: If you have stable angina (the most common type), you'll be given medicine to take when you have an angina attack. Titrate dosages to levels similar to those recommended for the fixed-combination preparation and administer both drugs at least 3 times daily. By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. VA class: CV250 Treatment of congestive heart failure. Tell your doctor that you're taking isosorbide mononitrate or dinitrate if you're going to be put to sleep (using general anaesthesia), or you're having any kind of major operation. Isosorbide dinitrate dose 30-120 mg daily in divided doses. Talk to your doctor if you want to stop taking isosorbide mononitrate or dinitrate. (See Geriatric Patients under Dosage.). By intravenous infusion. Nitrate therapy for stable angina pectoris. DESCRIPTION . In angina, isosorbide mononitrate and dinitrate works by widening blood vessels (veins and arteries). This increases the blood supply to your heart, which gets more oxygen to your heart muscles and this reduces chest pain. Figure 02: The Chemical Structure of Isosorbide Dinitrate. Below is a conversion table to enable using this preparation in place of standard release isosorbide mononitrate and modified release (M/R) preparations which are not going to be kept. At present there are twelve once-daily modified-release After introducing isosorbide, its popularity temporarily decreased as Needleman and his colleagues questioned its efficacy as it underwent extensive biotransformation in the liver. [15]When a longer duration of action is needed, clinicians can use a slow-release oral preparation that contains an amount of drug to withstand the hepatic metabolism and maintain the required therapeutic level. Answers. If your heart needs to work harder, during exercise for example, it needs increased blood flow to get more oxygen. Isosorbide dinitrate-hydralazine combination therapy in African Americans with heart failure. Distribution into human body tissues and fluids has not been fully characterized. Adults: Usual adult dose is one isosorbide mononitrate XL 60 mg tablet per day (taken in the morning).If necessary, the dosage may be increased to 120 mg once daily (i.e. Each Isosorbide mononitrate extended-release tablet, for oral administration contains 30 mg, 60 mg or 120 mg of ISMN. Nitroglycerin is the fastest-working medicine to relieve chest pain, but make sure to sit down before taking it. Isosorbide dinitrate fixed-combination tablets with hydralazine hydrochloride, peak: 60 minutes. Talk to your doctor if you're not sure it's safe for you to exercise. On the basis of V-HeFT I and II results, an application was filed with the Food and Drug Administration for a methods patent on the H-ISDN combination in 1987, 17 which would give marketing rights for the combination specifically for heart failure. Isosorbide mononitrate dose 10 mg twice daily to 120 mg daily in divided doses. ~}xp%0Vg^r3WT_a-~qvQD]dvo{,Z@${ssJC j(2GW`_? How can lifestyle changes help the health of my heart? Terms of Use and Privacy Policy: Legal. Isosorbide is available in two forms: isosorbide mononitrate and isosorbide dinitrate. Complete avoidance may not be possible, provided sufficient time elapses between use of the drugs. Some medicines can affect the way isosorbide mononitrate and dinitrate works. Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. Importance of informing patients receiving isosorbide dinitrate in fixed combination with hydralazine that inadequate fluid intake or excessive fluid loss due to diarrhea, vomiting, or perspiration may result in excessive hypotension, possibly leading to lightheadedness or syncope; if syncope occurs, discontinue treatment and notify clinician immediately. No specific dosage recommendations for renal impairment. Employ intermittent dosing of nitrates (e.g., use of a nitrate-free interval of 1012 hours daily) to minimize or prevent the development of tolerance to the hemodynamic and antianginal effects of the drugs. Visit Yellow Card for further information. [22], Isosorbide releases NO, which stimulates the soluble guanylate cyclase. Talk to your doctor if you're taking a combined hormonal contraceptive. Pharmacokinetics and pharmacodynamics of isosorbide dinitrate. How does isosorbide dinitrate work? They differ from each other according to their applications and properties. This is because it can lower your blood pressure too much when combined with some anaesthetics. Rapid titration (over 35 days) may be possible; however, slower titration may be needed due to adverse effects. Initially, isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg (1 tablet of BiDil) 3 times daily. ISDN allows you to exercise for up to eight hours. Taylor AL, Ziesche S, Yancy C, Carson P, D'Agostino R, Ferdinand K, Taylor M, Adams K, Sabolinski M, Worcel M, Cohn JN., African-American Heart Failure Trial Investigators. This helps your heart to work properly and reduces chest pain. Isosorbide mononitrate (ISMN) is widely used for the prophylaxis of angina pectoris. Conventional tablets: Approximately 100%. No significant differences in PP decline were demonstrated between the two groups (5.28 vs 7.49 mmHg in the active group and placebo, respectively, p = 0.79). Warn all patients receiving organic nitrates or nitrites about the potential interaction between the drugs and selective PDE inhibitors, even if they currently are not receiving the drugs, since there is substantial potential for patients to receive the drugs from another clinician, from a friend, with little or no clinical intervention (e.g., via the Internet), or illicitly. They differ from each other according to their applications and properties. Mnzel T, Steven S, Daiber A. Organic nitrates: update on mechanisms underlying vasodilation, tolerance and endothelial dysfunction. Contact dermatitis occurs in up to 40% of patients using transdermal Isosorbide dinitrate: Metabolized extensively; about 1525 and 7585% of a dose is metabolized to isosorbide-2-mononitrate and isosorbide-5-mononitrate (referred to simply as isosorbide mononitrate), respectively; both metabolites are pharmacologically active, especially isosorbide mononitrate. Overview and Key Difference 1. Isosorbide is relatively safe within the therapeutic range. Although many clinicians do not gradually reduce the dosage when discontinuance of oral nitrates is planned, it appears prudent that dosage be gradually reduced (e.g., over a period of about 1-2 weeks) to avoid withdrawal . Isosorbide mononitrate differs from isosorbide dinitrate according to the number of nitro groups per molecule. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. It is not suitable to take to treat an angina attack - you should always carry with you a short-acting nitrate, such as glyceryl trinitrate (GTN), for if you get angina pain. One manufacturer of isosorbide mononitrate states that dosage should be selected with caution, usually initiating therapy at the low end of the range, although age, renal, hepatic, and cardiovascular dysfunction do not appear to have a significant effect on drug clearance. Vasodilatory effect on arteriolar resistance is not as great as the action on the venous side; as a result of this combined action, both venous filling pressure (preload) and, to a lesser extent, arterial impedance (afterload) are reduced. Maximum 40 mg of isosorbide dinitrate and 75 mg of hydralazine hydrochloride (2 tablets of BiDil) 3 times daily. They work by preventing attacks from happening. The commonly available forms of isosorbide are: The adverse effects of isosorbide are due to the vasodilation of the venous capacitance vessels and the arterioles. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. It is as safe as other forms of exercise with similar levels of effort. Furthermore, there can be some severe effects as well, which include low blood pressure when exposed to PDE5 inhibitors, e.g. Isosorbide dinitrate conventional tablets, peak: 60 minutes. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Information Sheet. Adult 2-10 mg/hour, increased if necessary up to 20 mg/hour. The Role of Nitroglycerin and Other Nitrogen Oxides in Cardiovascular Therapeutics. endobj Sublingual: 2.5-10 mg every 4-6 hours. The elimination half-life of isosorbide dinitrate is 1 hour, while the elimination half-life of isosorbide mononitrate is 5 to 6 hours. Isosorbide is a medication used to treat and prevent angina pectoris in patients with coronary heart disease. Some people may be able to stop taking it after certain types of heart surgery. Prescription only. Daiber A, Mnzel T. Organic Nitrate Therapy, Nitrate Tolerance, and Nitrate-Induced Endothelial Dysfunction: Emphasis on Redox Biology and Oxidative Stress. In conclusion, in patients with heart failure with a preserved ejection fraction, the receipt of isosorbide mononitrate, as compared with placebo, decreased daily activity levels. Isosorbide mononitrate (ISMN) is the active metabolite of ISDN and is primarily used in the management of chronic stable angina. Breastfeeding will also benefit both you and your baby. Prevention or treatment of angina pectoris resulting from coronary artery disease - however, it is not recommended for use once the anginal episode has started because the onset of action is not sufficiently rapid enough to abort an acute anginal event. The development of tolerance is a significant concern during long-term isosorbide therapy. Manufacturers state that selective phosphodiesterase (PDE) inhibitors (e.g., sildenafil, tadalafil, vardenafil) are contraindicated in patients receiving nitrates. Isosorbide mononitrate comes as standard tablets and slow-release (modified release) tablets and capsules. Do not take non-steroidal anti-inflammatory medicines (NSAIDs) regularly, such as ibuprofen, aspirin and naproxen (unless it's prescribed by your doctor). If you have angina, to help avoid more attacks you may need to take at least 1 medicine every day for the rest of your life. Nitrates in the management of . Isosorbide Dinitrate Sublingual Isosorbide Dinitrate Isosorbide 5-Mononitrate 400 mcg/min. Nitrates work by widening blood vessels (veins and arteries). Particularly small stature, maintenance: Increased to at least 10 mg twice daily by the second or third day. <>stream The most common brand names of this medication are Monoket and Imdur. This medicine is particularly used in heart failure due to the ability of systolic dysfunction in combination with hydralazine. Isosorbide Dinitrate (ISDN) is an intermediate acting nitrate approved for prevention of angina pectoris. you have taken too much isosorbide mononitrate or dinitrate and: If you need to go to A&E, do not drive yourself get someone else to drive you or call an ambulance. The liver contains organic nitrate reductase, which removes the nitrate group in a stepwise manner and ultimately inactivates the drug. Isosorbide dinitrate: Also probably metabolized at extrahepatic sites. For example, if you are taking standard tablets twice a day, they may tell you to take 1 dose in the morning at 8am and the second dose in the afternoon at 2pm (leaving a gap of 6 hours between your first and . Parker JD, Parker JO. What isIsosorbide Dinitrate Aspirin or acetaminophen may relieve. The manufacturer of the fixed combination of isosorbide dinitrate and hydralazine hydrochloride states that dosage should be selected with caution because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy. However, if you have angina, oral contraceptives such as the combined pill are not recommended because they increase the risk of heart attack and stroke. Controlled medication release is achieved using the Durules principle of insoluble matrix embedding.Data from randomised double-blind trials show that IMD 60mg once daily (the most widely studied dosage) has significant antianginal and anti-ischaemic effects compared . x\[o~`kYH]r M 0-:/n77nnN,v.V"mYf/2[7bf?x>}>\wG }Nx'XT^FVw_fo ~;Hfz^@mlgz]3GD6'lKi~6A-,Bw Lt"i'1Y}=7Og b-yb@Y=lY(v -l`'c#EqxXhb MANO{65j5H$~$2J-;oHDI~ IY~wr_x Pleiotropic regulation of vascular smooth muscle tone by cyclic GMP-dependent protein kinase. Transient flushing may occur with the nitrates, and inhalation of amyl nitrite commonly causes cutaneous flushing of the head, neck, and clavicular area. The approximate onset and duration of action of various dosage forms of isosorbide dinitrate (ISDN) and isosorbide mononitrate (ISMN) are as follows: Onset and duration of action following intrabuccal administration are probably similar to those after sublingual administration of isosorbide dinitrate. Lincoln TM, Komalavilas P, Cornwell TL. In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to isosorbide mononitrate and isosorbide dinitrate. You do not need to avoid playing sports due to taking isosorbide mononitrate or dinitrate. [11]It directly increases the myocardial blood flow by dilating the large and medium-sized coronary arteries at higher doses. Isosorbide mononitrate and dinitrate comes as tablets, or capsules. Isosorbide mononitrate conventional tablets, peak: 0.51 hour. Imdur (isosorbide mononitrate) Extended Release and Isordil (isosorbide dinitrate) are vasodilators indicated for the prevention of angina pectoris due to coronary artery disease.. Side effects of Imdur and Isordil that are similar include headache and dizziness.. Side effects of Isordil that are different from Imdur include weakness and skin changes such as redness, tingling, or warmth. PI. Conventional tablets (e.g., Monoket): Tight, light-resistant containers at 1530C. 30% of the dose is available for immediate release and the remaining 70% is gradually released over time. Because of this decrease in the heart's workload, myocardial oxygen demand becomes reduced. Your doctor may increase your dose as needed. Isosorbide mononitrate and dinitrate are not used to treat sudden angina attacks. (adsbygoogle = window.adsbygoogle || []).push({}); Copyright 2010-2018 Difference Between. Posology. Molecular formula: C6H8N2O8C6H9NO6 Isosorbide mononitrate is an organic nitrate with vasodilating properties. The possibility of developing orthostatic hypotension in elderly patients, The possibility of developing severe hypotension when combined with Phosphodiesterase(PDE) inhibitors in male patients, The development of tolerance during chronic isosorbide therapy and drug-free intervals, The possibility of developing anginal pain during drug-free intervals. An interdosing interval sufficient to avoid tolerance to Dilatrate-SR extended-release capsules is not known, but it must exceed 18 hours. ;6YXZp2k>!'Z)IfFW`VG@Y!b /r980t ~pE Relieves chest pain. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. However, nitrate tolerance develops rapidly with persistent exposure and these agents are given in a way that allows for an 8 to 12 hour nitrate free period to restore efficacy. Target: 40 mg 3 times/day. According to pharmacokinetic data, isosorbide mononitrate has a bioavailability of about 95%, and its protein binding ability is about 5%. Treatment effect. If you are taking isosorbide mononitrate or dinitrate and are bothered by side effects, speak to your doctor. After oral administration, isosorbide dinitrate undergoes an extensive first-pass effect in the liver, reducing the oral bioavailability to 20 percent. Importance of informing patients of other important precautionary information. CAS number: 87-33-2. Sublingual or intrabuccal nitrates may be inadequately absorbed, with resultant decreased efficacy, in patients with dry oral mucous membranes (e.g., xerostomia). Treatment of chronic angina pectoris due to coronary artery disease. Method of administration. Nitrates are used to treat and prevent angina. You can report any suspected side effect using the Yellow Card safety scheme. ISDN works directly on the vascular smooth muscle in an identical manner to the natural endothelium derived relaxing factor, nitric oxide. Isosorbide dinitrate has been used effectively for diffuse esophageal spasm [off-label] without gastroesophageal reflux to relieve pain, dysphagia, and spasm. Other adverse effects can be due to the reflex activity of the sympathetic nervous system due to vasodilation. Short-acting nitrates such as sublingual nitroglycerin, isosorbide dinitrate, or nitroglycerin spray for treatment of acute attacks. Trade Name. cGMP-cGK-I inhibits theinositol-1,4,5-trisphosphate (IP3)-dependent calcium release, decreasing the intracellular calcium. Warn all patients taking either selective PDE inhibitors or organic nitrates or nitrites of the potential consequences of taking the drugs within close proximity (e.g., within 24 hours of sildenafil; possibly more prolonged periods of risk with longer-acting PDE inhibitors) of taking a nitrate- or nitrite-containing preparation. Conversion table Original isosorbide prescription: Convert to: 10 mg twice a day at 8am and 4pm 20 mg twice a day at 8am and 4pm mononitrate, isomannide mononitrate, isosorbide-2-mononitrate, and 5-ISMN. Like all medicines, isosorbide mononitrate and dinitrate can cause side effects, although not everybody gets them.
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