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Isosorbide is a medication used to treat and prevent angina pectoris in patients with coronary heart disease. It is in the nitrate class of drugs. This activity describes the indications, action, and contraindications for isosorbide as a valuable agent in treating angina pectoris due to coronary artery disease, heart failure with reduced ejection fraction, and achalasia. This activity will highlight the mechanism of action, adverse event profile, off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, and relevant interactions pertinent to the health care team members in managing patients with angina pectoris due to coronary artery disease and related conditions. Objectives: Identify the mechanism of action of isosorbide. Describe the potential adverse effects patients may experience when using isosorbide. Review the appropriate monitoring necessary with isosorbide. Summarize the importance of collaboration and communication amongst the interprofessional team to enhance care delivery and improve outcomes for patients with angina pectoris receiving isosorbide. Access free multiple choice questions on this topic.

Isosorbide is relatively safe within the therapeutic range. The oral lethal dose LD50 of isosorbide is 2010 mg/kg in rats and 1771 mg/kg in mice. Lethal dose LD50 of isosorbide has not been a topic of sufficient research in the human population. The symptoms of isosorbide overdose may arise from its vasodilating property causing profound systemic hypotension, heart block with bradycardia, syncope, nausea, vomiting, increased intracranial tension (probably along with persistent throbbing headache, fever, confusion), diaphoresis, dizziness, and palpitations. There is limited clinical information available for the management of isosorbide overdose. The venous hypotension and the arterial hypovolemia of isosorbide overdose can be managed clinically by: Administring normal saline. However, this may be hazardous in renal failure and congestive heart failure patients. Passive elevation of the patient's legs to reduce the venous pooling of blood Invasive monitoring of central fluid volume is advised in renal failure and congestive heart failure patients. The usage of epinephrine and other vasoconstrictors is generally not recommended. The methemoglobinemia associated with isosorbide toxicity is manageable by supportive care and cessation of isosorbide. Methylene blue can work as an antidote.[11] There is currently no evidence of teratogenicity or carcinogenicity potential of isosorbide.[11]

Due to the high prevalence of cardiovascular disease among the general population, effective management of anginal pain and heart failure with significant interprofessional communication plays a crucial role in reducing mortality and readmission rates with long-term benefits of improved exercise tolerance and quality of life. Isosorbide is used to manage anginal pain due to coronary artery disease, and it has approval for use in heart failure. The challenges of isosorbide therapy are drug interactions, adverse effects, and the development of tolerance during chronic isosorbide therapy. Multiple health care professionals such as cardiologists, general practitioners, nurses, pharmacists, home care workers, and dieticians can work together to overcome these challenges of isosorbide therapy. Some of the patient education strategies include educating regarding the following: The possibility of developing orthostatic hypotension in elderly patients The possibility of developing severe hypotension when combined with Phosphodiesterase(PDE) inhibitors in male patients The development of tolerance during chronic isosorbide therapy and drug-free intervals The possibility of developing anginal pain during drug-free intervals Home care workers can help elderly patients prone to developing orthostatic hypotension with Home safety measures. Nurses and general practitioners should ensure that isosorbide therapy is not an option for patients with erectile dysfunction by taking phosphodiesterase (PDE) inhibitors. Nurses and pharmacists can verify the compliance of the medication, appropriate drug-free intervals, common adverse effects, and drug interactions, and report appropriately to the prescribing general practitioner when needed. Isosorbide therapy in angina and heart failure requires an interprofessional team approach to achieve optimum results.