A single dose of a sustained-release preparation (60 mg of isosorbide dinitrate or 40 to 60 mg of isosorbide mononitrate), or 2 or 3 doses of a short-acting preparation (20-40 mg of isosorbide mononitrate) can be prescribed via the oral route. Long-acting isosorbide mononitrate 2-3 times anginal isosorbide mononitrate first-pass liver 100% bioavailability. Talk to your doctor if you're not sure it's safe for you to exercise. [11]It directly increases the myocardial blood flow by dilating the large and medium-sized coronary arteries at higher doses. 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 . 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. Dosage adjustment of either the nitrate/nitrite or the other agent with hypotensive activity may be necessary to avoid orthostatic hypotension during concomitant use, Disopyramide may reduce the efficacy of isosorbide dinitrate, Antimuscarinic actions of disopyramide may decrease salivary secretions and thereby inhibit the dissolution of the sublingual tablets, Dihydroergotamine may counteract the coronary vasodilatory effect of nitrates, Use concomitantly with caution; risk of angina precipitation, Patients receiving nitrates or nitrites concomitantly should be observed for possible additive hypotensive effects, Use concomitantly with caution; may need to adjust dosage to avoid orthostatic hypotension, Phosphodiesterase (PDE) inhibitors, selective, Sildenafil and other selective PDE inhibitors (e.g., tadalafil, vardenafil) profoundly potentiate the vasodilatory effects (e.g., a >25-mm Hg decrease in SBP) of organic nitrates and nitrites (e.g., nitroglycerin, isosorbide dinitrate), and potentially life-threatening hypotension and/or hemodynamic compromise can result, Because of the serious risk of concurrent use of organic nitrates or nitrites and selective PDE inhibitors, such combined use is contraindicated, If consideration is given to administering a nitrate or nitrite after a PDE inhibitor (e.g., >24 hours after sildenafil use), the response to the initial doses must be monitored carefully and proper facilities for fluid and vasopressor (e.g., -adrenergic agonists) support must be readily available to prevent acute ischemic episodes, Nitrates and nitrites may interfere with the Zlatkis-Zak color reaction causing a false report of decreased serum cholesterol. If a -blocker is not effective in controlling chronic stable angina, long-acting nitrates may be added to -blocker therapy. 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. The most common side-effect is headache. May cause blurred vision and should be discontinued if this symptom occurs. Readily (and almost completely) absorbed from the GI tract and oral mucosa, but considerable variations in the bioavailability (1090%) secondary to extensive first-pass metabolism in the liver. Treatment and prognosis of heart failure with preserved ejection . (dinitrate conventional tablets) two to three times daily. It is an anti-anginal agent that works by relaxing the smooth muscles of both arteries and veins, but but predominantly veins to reduce cardiac preload. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. If you stop taking isosorbide mononitrate or isosorbide dinitrate, your symptoms may get worse. The average delivery induction interval was significantly lower when isosorbide dinitrate-oxytocin was used (8.7 3.1 h) than when misoprostol-oxytocin (11.9 3.1 h) was used. Isosorbide mononitrate and dinitrate belong to a group of medicines called nitrates. This means you do not need to take them as often as standard tablets. In the latter case, glyceryl trinitrate is preferable. Not known whether isosorbide dinitrate and isosorbide mononitrate are distributed into milk. Apart from limiting alcohol, you can eat and drink normally while you are taking isosorbide mononitrate or dinitrate. ISDN has an extensive first pass metabolism in the liver, produces two major metabolites . 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. Isosorbide is excreted primarily through the kidney as glucuronide derivatives of the de-nitrated metabolite. They may need to change your dose. The diagnosis of methemoglobinemia requires arterial or venous blood gas with co-oximetry.[25]. Difference Between Isovalent and Sacrificial Hyperconjugation, Difference Between Naringin and Naringenin, What is the Difference Between Homolysis and Heterolysis, What is the Difference Between Myristoylation and Palmitoylation, What is the Difference Between Ortho Nitrophenol and Para Nitrophenol. 30% of the dose is available for immediate release and the remaining 70% is gradually released over time. Sublingual or intrabuccal nitrates may be inadequately absorbed, with resultant decreased efficacy, in patients with dry oral mucous membranes (e.g., xerostomia). At present there are twelve once-daily modified-release 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. With a mind rooted firmly to basic principals of chemistry and passion for ever evolving field of industrial chemistry, she is keenly interested to be a true companion for those who seek knowledge in the subject of chemistry. 1 0 obj . 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. Plasma concentrations and urinary excretion of isosorbide dinitrate and its metabolites in the dog. Isosorbide mononitrate: Metabolized principally in the liver, but unlike isosorbide dinitrate, does not undergo first-pass metabolism; metabolites appear to be pharmacologically inactive. This activity will . 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. Advise patients of the likelihood of headache, particularly with initial nitrate therapy. Let your provider know if they are excessive. These are not all the side effects of isosorbide mononitrate and isosorbide dinitrate. May need to adjust schedule for those arising earlier than 7 a.m. since early morning angina is common. There is no information about whether isosorbide mononitrate or dinitrate passes into breast milk, but the amounts are likely to be small. [Updated 2022 Jul 3]. <>>> Current guidelines recommend a combination of drug therapies (e.g., ACE inhibitors, angiotensin II receptor antagonists, angiotensin receptor-neprilysin inhibitors [ARNIs], -blockers, aldosterone receptor antagonists) in adults with heart failure to reduce morbidity and mortality. [13] Hence the sublingual route, which avoids the first-pass effect, is preferred to achieve the therapeutic levels rapidly. and whose molecular weight is 236.14. Invasive monitoring of central fluid volume is advised in renal failure and congestive heart failure patients. (isosorbide dinitrate) Sustained Release Capsules 40 mg . Isosorbide mononitrate and dinitrate usually starts to work within 1 hour. Talk to your doctor or pharmacist if these side effects bother you or last more than a few days: Serious side effects after taking isosorbide mononitrate and dinitrate are rare. Isosorbide dinitrate in fixed combination with hydralazine hydrochloride: About 2 hours. Christiansen I, Iversen HK, Olesen J. Headache characteristics during the development of tolerance to nitrates: pathophysiological implications. Komicki M, Sadowski Z, Szwed H, Kowalik I. This is called glyceryl trinitrate, or GTN. Heart failure - Treatment - Hydralazine and Isosorbide Dinitrate If you are taking isosorbide mononitrate or dinitrate and are bothered by side effects, speak to your doctor. Tarkin JM, Kaski JC. Isosorbide is used to manage anginal pain due to coronary artery disease, and it has approval for use in heart failure. In patients with hypertrophic cardiomyopathy, isosorbide decreases the preload and, hence, the left ventricular volume, worseningleft ventricular outflow tract obstruction.[11]. Inal ME, Egz AM. In addition, each tablet contains the . Isosorbide dinitrate or mononitrate can be used alone or in combination as either second-line or third-line therapy in patients previously treated with a -blocker. This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Maximum: 80 mg 3 times/day. When isosorbide dinitrate is used in fixed combination with hydralazine, consider the cautions, precautions, and contraindications associated with hydralazine. Side effects often improve as your body gets used to the medicine. This medicine is particularly used in heart failure due to the ability of systolic dysfunction in combination with hydralazine. This activity will highlight the mechanism of action, adverse event profile, off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions pertinent to the health care team members in managing patients with angina pectoris due to coronary artery disease and related conditions. The predominant venodilation results in decreased venous return to the heart by reducing the left ventricular end-diastolic volume, left ventricular end-diastolic pressure(preload), and the ventricular wall tension,therebyindirectly facilitating subendocardial blood flow. But it is less preferred compared to beta-blockers or calcium channel blockers. Tell your doctor if this happens to you. Usual initial dosage of conventional tablets (e.g., Monoket): 20 mg twice daily, with the 2 doses administered 7 hours apart. The most common side effects of isosorbide dinitrate include headache, lightheadedness when standing, and blurred vision. Transient flushing may occur with the nitrates, and inhalation of amyl nitrite commonly causes cutaneous flushing of the head, neck, and clavicular area. Isosorbide mononitrate (Monoket) is good for a specific type of chest pain (called angina), but it can cause headaches or dizziness after you take it. %PDF-1.5 Treatment of chronic angina pectoris due to coronary artery disease. After therapeutic doses, cardiac output may increase transiently and then decrease. Clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), should take a careful history so that concomitant use of organic nitrates or nitrites with selective PDE inhibitors can be avoided. May increase dosage to 120 mg (as a single 120-mg tablet or as two 60-mg tablets) once daily after several days; 240-mg dosages rarely needed. Orang awam lebih mengenalnya dengan penyakit angin . Laufen H, Aumann M, Leitold M. Oral absorption and disposition of isosorbide dinitrate and isosorbide mononitrates in man. Changing positions slowly can help lessen dizziness. (See Geriatric Patients under Dosage.). Nitrates in the management of chronic coronary syndrome. Talk to your doctor if you are having problems with your sex life. Isosorbide mononitrate is in the class of drugs called nitrates that are used for treating and preventing angina.Other nitrates include nitroglycerin (Nitrostat, NitroQuick, Nitrolingual, Nitro-Dur and others) and isosorbide dinitrate (Isordil Titradose, Dilatrate-SR, Isochron).Nitrates are vasodilators (dilators of blood vessels). Conventional oral tablets: 25% unchanged drug; about half that following sublingual administration (4050%). [18] They are as follows: PDE inhibitors such as tadalafil and sildenafil work by inhibiting the phosphodiesterase (PDE) enzyme, which is involved in breaking down the cGMP. After oral administration, isosorbide dinitrate undergoes an extensive first-pass effect in the liver, reducing the oral bioavailability to 20 percent. 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. Nitrate dependence is possible (documented in daily industrial exposures); withdrawal manifestations (e.g., ischemic symptoms, MI, sudden death) can occur. !W#Lgy endobj Nitrostat (Nitroglycerin) Relieves chest pain. 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. Isosorbide-5-mononitrate must not be used in cases of: hypersensitivity to isosorbide-5-mononitrate (the active substance), other nitrate compounds or to any of the excipients acute circulatory failure (shock, circulatory collapse) cardiogenic shock, unless a sufficiently high left-ventricular end-diastolic pressure is Etter EF, Eto M, Wardle RL, Brautigan DL, Murphy RA. Adjust dosage of isosorbide dinitrate and isosorbide mononitrate carefully according to the patient's requirements and response; use the smallest effective dosage. 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. Isosorbide dinitrate is a medication important in treating heart failure, oesophagal spasms, and treating chest pain that comes from not enough blood flow to the heart. Thadani U, Whitsett T. Relationship of pharmacokinetic and pharmacodynamic properties of the organic nitrates. Angina adalah rasa nyeri atau tidak nyaman di dada karena kurangnya aliran darah ke jantung. If you take isosorbide mononitrate or dinitrate 2 or 3 times a day, your doctor or pharmacist will explain how to space out your doses. Swallow the tablets or capsules whole with a drink of water. The liver contains organic nitrate reductase, which removes the nitrate group in a stepwise manner and ultimately inactivates the drug. It will take a few days to prevent angina symptoms. Patients with right ventricular infarction are preload sensitive. 4 0 obj The exact mechanism of action in the relief of angina pectoris has not been fully elucidated. Initially, (e.g., Imdur): 30 mg (as a single 30-mg tablet or as of a 60-mg tablet) or 60 mg (as a single 60-mg tablet) once daily. Their those has to be increased sufficiently to be given in oral form in maintenance therapy as these are rapidly degraded by liver with very low . Terms of Use and Privacy Policy: Legal. No more than 3 doses in a 15- to 30-minute period. After oral administration, isosorbide mononitrate EL has a quick onset of action (30 minutes) and effects are evident for . Principal pharmacologic property is relaxation of vascular smooth muscle, resulting in generalized vasodilation. According to pharmacokinetic data, isosorbide mononitrate has a bioavailability of about 95%, and its protein binding ability is about 5%. The key difference between isosorbide mononitrate and isosorbide dinitrate is that isosorbide mononitrate is primarily used in the management of chronic stable angina, whereas isosorbide dinitrate is recommended for heart failure. Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Side effects of Imdur and Ranexa that are similar include headache and dizziness. You are not required to obtain permission to distribute this article, provided that you credit the author and journal. ISDN works directly on the vascular smooth muscle in an identical manner to the natural endothelium derived relaxing factor, nitric oxide. [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. Combination of isosorbide dinitrate and hydralazine recommended by ACCF and AHA for self-identified black patients with NYHA class III or IV heart failure and reduced ejection fraction who are receiving optimal therapy with ACE inhibitors and -blockers, unless contraindicated. If this happens to you, do not drive, ride a bike or use tools or operate machinery until you feel better. Cardiology 24 years experience. (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be . This helps your heart to work properly and reduces chest pain. Isosorbide Mononitrate vs Isosorbide Dinitratein Tabular Form It has high . e5;O"]rQR8ku:mw/CYux:s8ofW`KMb`! Talk to your pharmacist if you need a painkiller stronger than paracetamol. The most common brand names of this medication are Monoket and Imdur. Isosorbide dinitrate is effective by mouth for the prophylaxis and treatment of angina; although the effect is slower in onset, it may persist for several hours. Leier CV, Huss P, Magorien RD, Unverferth DV. 1 hour following oral dosing. Isosorbide mononitrate has one nirate group and isosorbide dinatrate has 2 nitro groups. Isosorbide mononitrate and dinitrate are both generally safe to take for a long time. If you have darker skin your gums or the skin around your eyes may turn blue or grey these are signs of low oxygen levels in your body, your heart starts beating much faster or slower than usual, you get chest pain that is different or worse than your usual angina pain, you get severe pain in your eye, headache, blurred vision or you suddenly go blind in one eye these could be signs of acute angle closure glaucoma, you get a skin rash that may include itchy, red, swollen, blistered or peeling skin, your mouth, face, lips, tongue or throat start swelling, medicines for erection problems including, calcium channel blockers to relax the arteries, increasing blood supply to the heart muscle, build up your activity level gradually and take regular breaks, keep your GTN tablets or spray with you in case you need them, use your tablets or spray before starting exercise, if you need to. They differ from each other according to their applications and properties. <> Method of administration. Target: 40 mg 3 times/day. Importance of clinicians unfamiliar with their patients drug history, especially those involved in emergency care (e.g., for presumed myocardial infarction or ischemia), to take a careful history so that concomitant use with selective PDE inhibitors can be avoided. Maximum daily dosage of Dilatrate-SR: 160 mg (4 capsules). Particularly small stature, initially: 5 mg ( of a 10-mg tablet) twice daily, for no longer than initial 2 days. Isosorbide dinitrate or mononitrate is used for the acute relief of angina pectoris, for prophylactic management in situations likely to provoke angina attacks, and for long-term prophylactic management of angina pectoris. 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. 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 dilates the venous capacitance vessels, arterioles, and coronary arteries. Product and Consumer Medicine Information. It usually happens because your arteries have become hardened and narrowed. Tablets may be taken with or without food, and should be swallowed whole and not chewed. Isosorbide mononitrate and dinitrate can be taken by most adults aged 18 years and above. This effect is nitrate -specific and is not seen with non- nitrate sources of nitric oxide such . Serious adverse reactions to the organic nitrates and nitrites are uncommon and their adverse effects mainly involve the CNS and cardiovascular system. Sublingual isosorbide dinitrate and nitroglycerin are the two compounds used to treat acute angina. Usually you will take isosorbide mononitrate and dinitrate for a long time, possibly for the rest of your life. http://creativecommons.org/licenses/by-nc-nd/4.0/ Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Isosorbide mononitrate and dinitrate can make some people feel dizzy, sleepy or faint. Porje initiated the research on isosorbide in Stockholm, and the drug was marketed in Sweden in 1946. Isosorbide mononitrate (ISMN) is widely used for the prophylaxis of angina pectoris. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Modified-release preparations can have a duration of action up to 12 hours. Keep taking your medicine until you have had your review. By decreasing myocardial oxygen consumption, nitrates and nitrites alter the imbalance of myocardial oxygen supply and consumption which is thought to cause angina pectoris. % Fung HL. Isosorbide mononitrate and dinitrate can be taken in pregnancy. Take the first dose in the morning right after you . Isosorbide mononitrate slow-release tablets or capsules: Isosorbide dinitrate slow-release tablets: Isosorbide dinitrate immediate release tablets: Taking too much isosorbide mononitrate or dinitrate may cause your blood pressure to fall too low, making you feel sick, faint and dizzy. Conventional measures in the management of angina pectoris are aimed at reducing the frequency, duration, and severity of attacks, and include coronary risk reduction (e.g., discontinuance of smoking, weight control, antilipemic strategies), rest, avoidance of precipitating circumstances (e.g., eating heavy meals, getting emotionally upset, performing strenuous exercise, exposure to cold air) and, if possible, treatment of the underlying cause. Angina and heart failure is a warning sign that you are at risk of serious problems such as heart attacks and strokes. Isosorbide Dinitrate (ISDN) is an intermediate acting nitrate approved for prevention of angina pectoris. For a full list, see the leaflet inside your medicines packet. Isosorbide dinitrate: Food may decrease substantially mean peak plasma concentrations, yet total bioavailability does not seem to be affected. This medication is commercially available in two forms: as an oral tablet both in extended-release and slow release. It's important that you keep taking your medicine to keep you well. Aspirin or acetaminophen may relieve. Daiber A, Mnzel T. Organic Nitrate Therapy, Nitrate Tolerance, and Nitrate-Induced Endothelial Dysfunction: Emphasis on Redox Biology and Oxidative Stress. Extended-release oral nitrate preparations should not be used in patients with functional or organic GI hypermotility or malabsorption syndrome. Available for Android and iOS devices. How does isosorbide dinitrate work? 2 0 obj Or 30 to 60 mg (mononitrate extended-release tablets) once daily. -Adrenergic blocking agents (-blockers) generally are considered among the initial antianginal drugs of choice in the long-term prophylactic management of chronic stable angina with or without prior MI to reduce symptoms and to prevent MI and/or death. Talk to your doctor if you're taking a combined hormonal contraceptive. 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. Selective PDE inhibitors can potentiate the hypotensive effects of organic nitrates and nitrites, possibly resulting in potentially life-threatening hypotension and/or hemodynamic compromise. Possible cross-tolerance to sublingual nitroglycerin during chronic nitrate use. Isosorbide mononitrate and dinitrate are types of heart medicine called nitrates. ;6YXZp2k>!'Z)IfFW`VG@Y!b /r980t ~pE If you take other medicines that lower blood pressure with isosorbide mononitrate and dinitrate, it can sometimes lower your blood pressure too much. Isosorbide. In addition . Drinking alcohol can increase the effects of isosorbide mononitrate and dinitrate. 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. In: StatPearls [Internet]. Importance of informing patients of other important precautionary information. To reduce your risk of problems like these, it may help to: Page last reviewed: 1 July 2021 Figure 01: The Chemical Structure of Isosorbide Mononitrate. The key difference between isosorbide mononitrate and isosorbide dinitrate is that isosorbide mononitrate is primarily used in the management of chronic stable angina, whereas isosorbide dinitrate is recommended for heart failure.. Isosorbide mononitrate and isosorbide dinitrate are important medications for some heart diseases. 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. They differ from each other according to their applications and . Hypertensive crisis: short-term reduction of blood pressure. Initially, isosorbide dinitrate 20 mg and hydralazine hydrochloride 37.5 mg (1 tablet of BiDil) 3 times daily. [8][9], The decreased intracellular calcium inhibits the myosin light chain kinase(MLCK). Isosorbide mononitrate and dinitrate comes as tablets, or capsules. %&SC*U]0l TCLg&=|G==!bT=4Er R|qB^RzA-C%#^krR(Luhiy7c+>Vour]ZOf?HV Importance of warning 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. Along with non-selective beta-blockers (NSBB), it can be used as secondary prophylaxis in preventing recurrent variceal hemorrhage. Imdur is a vasodilator and Ranexa is an anti-anginal medication. Imdur and Ranexa belong to different drug classes. Administer extended-release tablets with adequate amounts of fluid (e.g., 120 mL) on arising in the morning. What intervals in oral therapy of isosorbide dinitrate in various doses are sufficient to prevent nitrate tolerance? In angina, isosorbide mononitrate and dinitrate works by widening blood vessels (veins and arteries). [2] Review the appropriate monitoring necessary with isosorbide. Isosorbide mononitrate differs from isosorbide dinitrate according to the number of nitro groups per molecule. Thadani U, Rodgers T. Side effects of using nitrates to treat angina. No specific dosage recommendations for renal impairment. The methemoglobinemia associated with isosorbide toxicity is manageable by supportive care and cessation of isosorbide. Isosorbide Dinitrate Sublingual Isosorbide Dinitrate Isosorbide 5-Mononitrate 400 mcg/min. Caution if used in nursing women. Your email address will not be published. Isosorbide dinitrate: Also probably metabolized at extrahepatic sites. Importance of consulting clinician if headache continues with repeated dosing. The elimination half-life of isosorbide dinitrate is 1 hour, while the elimination half-life of isosorbide mononitrate is 5 to 6 hours. %H$Z7. Tolerance to the vascular and antianginal effects of individual nitrates and cross-tolerance among the drugs may occur with repeated, prolonged use. This might make you feel dizzy or faint. ISDN is available in immediate release (Ex: Isordil) and extended release (Ex: DilatrateSR ) forms. cGMP-cGK-I inhibits theinositol-1,4,5-trisphosphate (IP3)-dependent calcium release, decreasing the intracellular calcium. You'll usually take these medicines for a long time, possibly for the rest of your life. In addition, the elimination time ofisosorbide mononitrate is about 5 hours whereasthe elimination time ofisosorbide dinitrate is 1 hour.