Isosorbide is a heterocyclic compound derived from glucose and is thus a biofeedstock. Glucose can be hydrogenated to sorbitol, which upon double dehydration gives isosorbide. The picture shown to the right is a simplification, since only one enantiomer is formed from sorbitol.
Two medications derived from isosorbide are used to treat angina pectoris: isosorbide dinitrate or isosorbide mononitrate. Other isosorbide-based medicines are used as osmotic diuretics and for treatment of esophageal varices. Like other nitric oxide donors (see biological functions of nitric oxide), this drug lowers portal pressure by vasodilation and decreasing cardiac output.
Reduces cardiac oxygen demand decreasing left ventricular end diastolic pressure (preload) and to a lesser extent,systemic vascular resistance (afterload). Also increases blood flow through the collateral coronary vessels.
♦ Acute anginal attacks; to prevent situations that may cause anginal attacks
♦5mg/ tab S.L. for chest pain every 15 mins.
Contraindicated in patients hypersensitive to nitrites, head trauma, cerebral hemorrhage or severe anemia.
Use cautiously in hypotension.
CNS: headache, throbbing, dizziness, weakness
CV: orthostatic hypotension. tachycardia, palpitation, ankle edema, fainting
GI: nausea and vomiting
Skin: cutaneous vasodilation, flushing
Antihypertensives: possibly increased hypotensive effects. Monitor closely during initial therapy.
♦ Monitor blood pressure and intensity and duration of response to drug.
♦ Advise patient to avoid alcoholic beverages; they may produce increased hypotension.
♦ Warn patient not to confuse sublingual with oral form.
♦ Store in cool place, in tightly closed container, away from light.