Isosorbide Dinitrate Dosage

Usual Adult Dose for Angina Pectoris

Initial: 2.5 mg (SL) or 5 mg (Chew) once and repeat as needed as soon as the tablet has dissolved or chewed.
The dose may be doubled and titrated upwards as tolerated. The onset of action is within 3 minutes.

Usual Adult Dose for Angina Pectoris Prophylaxis

Initial SR: 40 mg orally every 8 to 12 hours.
Maintenance SR: 10 to 40 mg every 8 to 12 hours.
Initial tab: 5 mg orally every 6 hours.
Maintenance tab: 10 to 40 mg every 6 hours.
Initial SL: 5 mg every 2 to 3 hours.
Maintenance SL: Not recommended for prophylaxis.
Initial Chew: 5 mg every 2 to 3 hours.
Maintenance Chew: Not recommended for prophylaxis.

Usual Adult Dose for Esophageal Spasm

Initial SR: 20 mg every 8 to 12 hours.
Maintenance SR: 20 to 40 mg every 8 to 12 hours.
Initial Tab: 10 mg every 6 hours.
Maintenance SR: 10 to 20 mg every 6 hours.

Usual Adult Dose for Congestive Heart Failure

Initial SR: 20 mg every 8 to 12 hours.
Maintenance SR: 20 to 80 mg every 8 to 12 hours.
Initial tab: 10 mg orally every 6 to 8 hours.
Maintenance tab: 10 to 40 mg every 6 to 8 hours.
Initial SL: 5 mg every 3 to 4 hours.
Maintenance SL: 5 to 10 mg every 3 to 4 hours.
Initial Chew: 10 mg every 4 hours.
Maintenance Chew: 10 to 40 mg every 4 hours.

Usual Adult Dose for Pulmonary Hypertension

Initial SR: 40 mg every 8 to 12 hours.
Maintenance SR: 40 to 80 mg every 8 to 12 hours.
Initial tab: 5 mg every 6 hours.
Maintenance tab: 5 to 20 mg every 6 hours.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Precautions

A daily dose free interval of at least 14 hours is advisable to minimize tolerance; however, the optimal interval will vary depending on the individual patient and treatment plan.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Usually recommended to administer a dose post hemodialysis, or administer a supplemental 10 to 20 mg dose. A supplemental dose is not necessary with peritoneal dialysis.

Other Comments

Because of the more rapid effect of sublingual nitroglycerin, the use of chewable or sublingual isosorbide is not recommended and should be limited to those patients who are intolerant or unresponsive to sublingual nitroglycerin.

See also...