← Search & browse all drugs
CARDIOVASCULAR SYSTEM › CARDIAC THERAPY › VASODILATORS USED IN CARDIAC DISEASES › Organic nitrates
isosorbide dinitrate, combinations
C01DA58
Forms & Strengths
- Fixed-dose combination capsules: Isosorbide dinitrate 20 mg / Hydralazine hydrochloride 37.5 mg
Adult Dosing
- Initial: 1 capsule (isosorbide dinitrate 20 mg/hydralazine 37.5 mg) orally 3 times daily
- Maintenance: Titrate up to maximum of 2 capsules 3 times daily as tolerated
Pediatric Dosing
- Safety and efficacy not established in pediatric patients
Indications
- Treatment of heart failure as an adjunct to standard therapy to improve survival, exercise detachment, and quality of life in self-identified black patients
Mechanism of Action
- Isosorbide dinitrate acts as a vasodilator releasing nitric oxide, relaxing vascular smooth muscle primarily on veins and arteries
- Hydralazine acts as a direct-acting arteriolar vasodilator, reducing afterload and decreasing oxidative stress to enhance nitrate responsiveness
Contraindications
- Concomitant use with phosphodiesterase-5 (PDE-5) inhibitors (e.g., sildenafil, tadalafil, vardenafil)
- Concomitant use with soluble guanylate cyclase (sGC) stimulators (e.g., riociguat)
- Hypersensitivity to isosorbide dinitrate, hydralazine, or other nitrates
Adverse Reactions
- Headache
- Dizziness
- Hypotension (including orthostatic hypotension)
- Tachycardia
- Nausea
- Drug-induced lupus syndrome (due to hydralazine component)
Drug Interactions
- PDE-5 inhibitors: Severe, potentially life-threatening hypotension
- sGC stimulators: Risk of profound hypotension
- Antihypertensives, alcohol, and beta-blockers: Additive hypotensive effects
- MAO inhibitors: Marked potentiation of hydralazine's hypotensive effect
Curated Content: Needs Vetting Before Put to Clinical Use