II. General

  1. Need 10-12 hours Nitroglycerin free interval per day
  2. Not proven to reduce Incidence of future events

III. Indications

  1. Chronic Angina Pectoris
  2. Not indicated for acute Myocardial Ischemia

IV. Preparations: Long acting

  1. Isosorbide Dinitrate (Isordil)
    1. Reg: 10 to 40 mg PO tid (7am, 12 noon, 5pm)
    2. SR: 40-80 mg PO bid (8am, 3pm)
  2. Isosorbide Mononitrate
  3. Nitroglycerin sustained release (Nitro-Bid)

V. Preparations: Transdermal

  1. Nitroglycerin 2% ointment (15 mg per inch)
    1. Start: 0.5 inch q8 hours
    2. Maintenance: 1-2 inches q8 hours
    3. Maximum: 4-5 inches q4 hours
  2. Transdermal Nitroglycerin
    1. Apply 1 patch for 12-14 hours per day
    2. Doses range from 0.1 to 0.8 mg per hour

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Cost: Medications

Isosorbide Mononitrate (on 6/18/2017 at Walmart.com)
Isosorbide Mononitrate 30mg ER #30 tablets for $4.00 $0.13 each
Isosorbide Mononitrate 30mg ER #90 tablets for $10.00 $0.11 each
Isosorbide Mononitrate 60mg ER #30 tablets for $4.00 $0.13 each
Isosorbide Mononitrate 60mg ER #90 tablets for $10.00 $0.11 each
isosorbide (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
ISOSORBIDE DN 10 MG TABLET Generic $0.58 each
ISOSORBIDE DN 20 MG TABLET Generic $0.64 each
ISOSORBIDE DN 30 MG TABLET Generic $0.75 each
ISOSORBIDE DN 5 MG TABLET Generic $0.58 each
ISOSORBIDE DN ER 40 MG TABLET Generic $1.41 each
ISOSORBIDE MN 10 MG TABLET Generic $0.17 each
ISOSORBIDE MN 20 MG TABLET Generic $0.15 each
ISOSORBIDE MN ER 120 MG TAB Generic $0.42 each
ISOSORBIDE MN ER 30 MG TABLET Generic $0.16 each
ISOSORBIDE MN ER 60 MG TABLET Generic $0.20 each

Ontology: Isosorbide (C0022251)

Definition (CHV) a drug used to prevent or treat chest pain (angina).
Definition (NCI) An organic nitrate with vasodilator activity. Isosorbide relaxes vascular smooth muscle by formation of the free radical nitric oxide (NO), which is identical to the endothelium-derived relaxing factor (EDRF). NO activates guanylyl cyclase, thereby increasing the synthesis of cGMP within smooth muscle. Elevated cGMP levels in smooth muscle activate cGMP-dependent kinase activity that leads to release of sequestered Ca2+. In turn, free Ca+ triggers dephosphorylation of light chain myosin and relaxation of peripheral arteries and veins. In addition isosorbide relaxes coronary arteries, thereby increasing the blood circulation through the ischemic area.
Definition (MSH) 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma.
Concepts Pharmacologic Substance (T121) , Carbohydrate (T118)
MSH D007547
SnomedCT 108478001, 386853004
LNC LP171613-5
English Isosorbide, D-Glucitol, 1,4:3,6-dianhydro-, isosorbide, Isosorbide [Chemical/Ingredient], ISOSORBIDE, Isosorbide (product), Isosorbide (substance)
Swedish Isosorbid
Czech isosorbid
Finnish Isosorbidi
Russian IZOSORBID, ИЗОСОРБИД
Japanese イソソルビド
Croatian IZOSORBID
Spanish Isosorbida, isosorbida (producto), isosorbida (sustancia), isosorbida
Polish Izosorbid
Portuguese Isossorbido, Isossorbida
French Isosorbide
German Isosorbid
Italian Isosorbide

Ontology: Isosorbide Dinitrate (C0022252)

Definition (NCI) The dinitrate salt form of isosorbide, an organic nitrate with vasodilator activity. Isosorbide dinitrate relaxes vascular smooth muscle by formation of the free radical nitric oxide (NO), which is identical to the endothelium-derived relaxing factor (EDRF). NO activates guanylyl cyclase, thereby increasing the synthesis of cGMP within smooth muscle, resulting in dephosphorylation of light chain myosin and relaxation of peripheral arteries and veins. In addition, isosorbide dinitrate relaxes coronary arteries, thereby increasing the blood circulation through the ischemic area. (NCI05)
Definition (MSH) A vasodilator used in the treatment of ANGINA PECTORIS. Its actions are similar to NITROGLYCERIN but with a slower onset of action.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D007548
SnomedCT 387332007, 5924003
English Dinitrate, Isosorbide, ISDN, Isosorbide Dinitrate, D-Glucitol, 1,4:3,6-dianhydro-, dinitrate, isosorbide dinitrate, isosorbide dinitrate (medication), vasodilators coronary isosorbide dinitrate, ISOSORBIDE DINITRATE, Isosorbide Dinitrate [Chemical/Ingredient], isd, isdn, Isosorbide dinitrate, ISD, ISDN - isosorbide dinitrate, sorbide nitrate, Isosorbide dinitrate (product), Isosorbide dinitrate (substance)
Swedish Isosorbiddinitrat
Czech isosorbiddinitrát
Finnish Isosorbididinitraatti
French Dinitrate d'isosorbide, Dinitrate isosorbide
Russian IZOSORBIDA DINITRAT, NITROSORBID, ИЗОСОРБИДА ДИНИТРАТ, НИТРОСОРБИД
Japanese 二硝酸イソソルビド, 硝酸イソソルビド, イソソルビドジニトラート, イソソルビド二硝酸
Croatian IZOSORBID DINITRAT
Polish Diazotan izosorbidu, Dwuazotan izosorbidu
Spanish dinitrato de isosorbida (producto), dinitrato de isosorbida (sustancia), dinitrato de isosorbida, Dinitrato de Isosorbide
German Isosorbiddinitrat
Italian Dinitrato di isosorbide
Portuguese Dinitrato de Isossorbida

Ontology: Isosorbide Mononitrate (C0064079)

Definition (NCI) The mononitrate salt form of isosorbide, an organic nitrate with vasodilator activity. Isosorbide mononitrate relaxes vascular smooth muscle by formation of the free radical nitric oxide (NO), which is identical to the endothelium-derived relaxing factor (EDRF). NO activates guanylyl cyclase, thereby increasing the synthesis of cGMP within smooth muscle, resulting in dephosphorylation of light chain myosin and relaxation of peripheral arteries and veins. In addition, isosorbide mononitrate relaxes coronary arteries, thereby increasing the blood circulation through the ischemic area. (NCI05)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C030397
SnomedCT 108484003, 386854005
English 5-ISMN, isosorbide-5-mononitrate, isosorbide-5-nitrate, 1,4:3,6-Dianhydro-D-glucitol 5-nitrate, isosorbide mononitrate, monocinque, isosorbide mononitrate (medication), Isosorbide Mononitrate, ISOSORBIDE MONONITRATE, isosorbide-5-mononitrate [Chemical/Ingredient], mononitrate isosorbide, isosorbide 5 mononitrate, ISMN - isosorbide mononitrate, ISMO - isosorbide mononitrate, Isosorbide mononitrate, Isosorbide mononitrate product, Isosorbide mononitrate (product), Isosorbide mononitrate (substance)
Spanish mononitrato de isosorbida (producto), mononitrato de isosorbida (sustancia), mononitrato de isosorbida

Ontology: Nitroglycerin 0.02 MG/MG Topical Ointment (C0782070)

Concepts Clinical Drug (T200)
SnomedCT 319407007
English Glyceryl trinitrate 2% oint, NITROGLYCERIN 2% TRANSDERMAL OINTMENT(GM), NITROGLYCERIN 2% Transdermal ointment, Nitroglycerin 0.02 MG/MG Topical Ointment, NITROGLYCERIN 2 %WW TOPICAL OINTMENT, NITROGLYCERIN 2% OINTMENT(GM), NITROGLYCERIN @ 2% @ OINTMENT(GM), NITROGLYCERIN 2% TRANSDERM. OINTMENT(GM), NITROGLYCERIN@2%@TRANSDERM.@OINTMENT(GM), Nitroglycerin 2% Topical ointment, NITROGLYCERIN@2 %@TRANSDERM.@OINTMENT(GM), NITROGLYCERIN 2 % TRANSDERM. OINTMENT(GM), NITROGLYCERIN 2% OINT, nitroglycerin 2 % Topical Ointment, Nitroglycerin 2% Topical application Ointment, Nitroglycerin Oint 2%, NITROGLYCERIN 2% OINT,TOP [VA Product], NITROGLYCERIN 2 % TRANSDERM OINTMENT(GM), NITROGLYCERIN 2 % TRANSDERM OINTMENT (GRAM), NITROGLYCERIN@2 %@TRANSDERM@OINTMENT (GRAM), NITROGLYCERIN@2 %@TRANSDERM@OINTMENT(GM), nitroglycerin 2% transdermal ointment, Nitroglycerin, 2% transdermal ointment, nitroglycerin 2% topical ointment, Nitroglycerin, 2% topical ointment, Nitroglycerin 2% Transdermal Ointment, NTG 0.02 MG/MG Topical Ointment, TNG 0.02 MG/MG Topical Ointment, Glyceryl trinitrate 2% ointment, Glyceryl trinitrate 2% ointment (product), Glyceryl trinitrate 2% ointment (substance), NITROGLYCERIN 2% OINT,TOP
Spanish trinitrato de glicerilo, 2%, pomada, trinitrato de glicerilo, 2%, ungüento (producto), trinitrato de glicerilo, 2%, ungüento

Ontology: Transdermal glyceryl trinitrate (C1445777)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
SnomedCT 412446007, 346462009
English Transdermal GTN, transdermal glyceryl trinitrate, Transdermal nitroglycerin (product), Transdermal glyceryl trinitrate, Transdermal glyceryl trinitrate (product), Transdermal glyceryl trinitrate (substance), Transdermal nitroglycerin
Spanish nitroglicerina transdérmica (producto), trinitrato de glicerilo transdérmico (producto), trinitrato de glicerilo transdérmico, nitroglicerina transdérmica