Vasodilator
The major active metabolite of isosorbidedinitrate, is an organic nitrate used to prevent angina. It exerts its effectby relaxing vascular smooth muscles resulting in dilatation of peripheralarteries and veins.

Absorption:
1. Tmax: 30-60 minutes
2. Bioavailability: Nearly 100%
3. Effect of food: No significant effect.
Distribution:
1. Vd: Approximately 0.6-0.7 L/k
2. Protein binding: Approximately 5%.
Metabolism:
Hepatic; denitration, glucuronidation, hydration
Excretion:
1. Fecal: About 1%; Renal: 93-96%, 2% unchanged
2. Dialyzable: Yes (hemodialysis); No (peritoneal dialysis)
Elimination Half Life: 5 hours

Concomitant use of phosphodiesterase inhibitors, concomitant riociguatuse

B (FDA), B2 (AUS)

Infant risk cannot be ruled out

>10%:
CNS: Headache (13-35%)
1% to 10%:
CV: Angina pectoris, flushing
CNS: Dizziness, fatigue, pain, emotional lability
Dermatologic: Pruritus,skin rash
GI: Nausea, abdominal pain, diarrhea
Hypersensitivity: Hypersensitivity reaction
Respiratory: Upper respiratory infection, increased cough

1. Initial 20 mg ORALLY every morning, then 20 mg 7 hours later
1. Initial 30 to 60 mg once daily in the morning
2. May titrate after several days to 120 mg once daily; rarely, 240 mg once daily may be required.

Safety and efficacy not established

Mild to severe impairment: No dosage adjustment necessary
Hemodialysis, Peritoneal dialysis: No supplemental dose or dosage adjustment necessary (manufacturer's labeling)

No dosage adjustment necessary.