What is Isomack?
Preventing symptoms of angina (chest pain) caused by heart disease. Isomack extended-release capsules is used alone or with other medicines. Isomack extended-release capsules is NOT intended for the immediate relief of acute attacks of angina. It may also be used for other conditions as determined by your doctor.
Isomack extended-release capsules is a nitrate. It works by relaxing the blood vessels in the body, allowing them to widen. This lets more blood flow through the blood vessels, which reduces the work the heart has to do to pump blood. This reduces the oxygen needs of the heart and makes chest pain go away.
Isomack indications
Angina Pectoris:Oral Tablet:
Prophylaxis of ischemic heart pain associated with coronary insufficiency. Isomack may reduce the frequency, duration and severity of anginal attacks. Exercise tolerance may be improved and the need for nitroglycerin may be reduced. The oral tablets are not indicated for the treatment of an anginal attack.
Sublingual Tablet: Treatment of angina pectoris and prophylaxis in situations likely to provoke an anginal attack ie, physical or emotional stress.
Congestive Heart Failure: Acute and chronic congestive heart failure (including that associated with myocardial infarction). Based on current knowledge, Isomack should be considered only as an adjunct to the more conventional modes of therapy (cardiac glycosides and diuretics); however, in refractory cases, it may be used alone or concomitantly with other vasodilators. Isomack is particularly effective in patients with increased left ventricular end diastolic pressure (LVEDP), "backward failure" and normal or approximately normal cardiac output in whom pulmonary congestion or edema is the primary problem. Isomack is especially recommended when coronary artery disease is the cause of congestive heart failure, in which case its antianginal effect is of additional value.
How should I use Isomack?
Use Isomack extended-release capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Take Isomack extended-release capsules by mouth on an empty stomach with a full glass of water (8 oz [240 mL]).
- Swallow Isomack extended-release capsules whole. Do not break, crush, or chew before swallowing.
- If you miss a dose of Isomack extended-release capsules, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Isomack extended-release capsules.
Uses of Isomack in details
Use: Labeled Indications
Angina pectoris, prevention: Prevention of angina pectoris due to coronary artery disease.
Note: Due to slower onset of action, Isomack is not the drug of choice to abort an acute anginal episode.
Off Label Uses
Achalasia
Based on the American College of Gastroenterology (ACG) guidelines on the diagnosis and management of achalasia, Isomack may be considered for patients with achalasia who cannot use or refuse more definitive therapies (pneumatic dilation or surgical myotomy) and patients who have failed botulinum toxin injections.
Heart failure with reduced ejection fraction
Data from a randomized, double-blind trial comparing enalapril and hydralazine plus Isomack in patients with chronic heart failure support the use of Isomack (in combination with hydralazine) in patients with intolerance to ACE inhibitor therapy.
Isomack description
Each tablet of Isomack 5 mg contains 5 mg of Isomack.
Each tablet of Isomack 10 mg contains 10 mg of Isomack.
Each sustained-release tablet of Isomack 20 mg contains 20 mg of Isomack.
Each sustained-release tablet of Isomack 40 mg contains 40 mg of Isomack.
Isomack dosage
As noted under "CLINICAL PHARMACOLOGY," multiple-dose studies with Isomack and other nitrates have shown that maintenance of continuous 24-hour plasma levels results in refractory tolerance. Every dosing regimen for Isomack tablets must provide a daily dose-free interval to minimize the development of this tolerance. With immediate-release Isomack, it appears that one daily dose-free interval must be at least 14 hours long.
As also noted under "CLINICAL PHARMACOLOGY," the effects of the second and later doses have been smaller and shorter-lasting than the effects of the first.
Large controlled studies with other nitrates suggest that no dosing regimen with Isomack tablets should be expected to provide more than about 12 hours of continuous anti-anginal efficacy per day.
As with all titratable drugs, it is important to administer the minimum dose which produces the desired clinical effect. The usual starting dose of Isomack is 5 mg to 20 mg, two or three times daily. For maintenance therapy, 10 mg to 40 mg, two or three times daily is recommended. Some patients may require higher doses. A daily dose-free interval of at least 14 hours is advisable to minimize tolerance. The optimal interval will vary with the individual patient, dose and regimen.
Isomack interactions
See also:
What other drugs will affect Isomack?
Blood Pressure Lowering Agents: The concomitant use of drugs with blood pressure lowering properties, e.g. vasodilators, beta-blockers, calcium channel antagonists, ACE inhibitors, neuroleptics or tricyclic antidepressants and alcohol may potentiate the antihypertensive effect of Isomack.
Phosphodiesterase Inhibitors: A blood pressure lowering effect of Isomack will be increased, if used together with phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, vardenafil). This might lead to life-threatening cardiovascular complications. Patients who are on Isomack therapy therefore must not use phosphodiesterase inhibitors (e.g. sildenafil, tadalafil, vardenafil).
Patients who have recently taken phosphodiesterase inhibitors (e.g. sildenafil, vardenafil, tadalafil) therefore must not receive acute Isomack therapy.
Dihydroergotamine: Isomack used in combination with dihydroergotamine may lead to higher blood concentration of dihydroergotamine and thus increase the effect of this medicinal product.
Sapropterine: Sapropterine contains the API Tetrahydrobiopterine (BH4). BH4 is a cofactor for nitric oxide synthetase. Caution is recommended during concomitant use of sapropterine-containing medicine with all agents that cause vasodilation by affecting nitric oxide (NO) metabolism or action, including classical NO donors [e.g. glyceryl trinitrate (GTN), Isomack (ISDN), Isomack mononitrate and others].
Isomack side effects
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What are the possible side effects of Isomack?
Adverse reactions to Isomack are generally dose-related, and almost all of these reactions are the result of Isomack's activity as a vasodilator. Headache, which may be severe, is the most commonly reported side effect. Headache may be recurrent with each daily dose, especially at higher doses. Transient episodes of lightheadedness, occasionally related to blood pressure changes, may also occur. Hypotension occurs infrequently, but in some patients it may be severe enough to warrant discontinuation of therapy. Syncope, crescendo angina, and rebound hypertension have been reported but are uncommon.
Extremely rarely, ordinary doses of organic nitrates have caused methemoglobinemia in normal-seeming patients. Methemoglobinemia is so infrequent at these doses that further discussion of its diagnosis and treatment is deferred.
Data are not available to allow estimation of the frequency of adverse reactions during treatment with Isomack tablets.
To report SUSPECTED ADVERSE REACTIONS contact AvKARE, Inc. at 1-855-361-3993; email drugsafety@avkare.com; or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Isomack contraindications
See also:
What is the most important information I should know about Isomack?
Do not use Isomack if you are taking sildenafil (Viagra). Serious, life-threatening side effects can occur if you take Isomack while you are using sildenafil.
You should not use this medication if you are allergic to Isomack, Isomack mononitrate (Imdur, ISMO, Monoket), or nitroglycerin, or if you have early signs of a heart attack (chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling).
Before taking Isomack, tell your doctor if you have congestive heart failure, low blood pressure, or kidney disease.
Isomack can cause severe headaches, especially when you first start using it. These headaches may gradually become less severe as you continue to use the medication. Do not stop taking Isomack. Ask your doctor before using any headache pain medication.
Only the sublingual tablet should be used to treat an angina attack that has already begun.
Isomack regular and extended-release tablets are used to prevent angina attacks but will not treat an angina attack.
It is important to keep taking this medicine as directed to prevent an angina attack. Get your prescription refilled before you run out of medicine completely.
Do not stop taking Isomack suddenly. Stopping suddenly could cause a severe angina attack.
Active ingredient matches for Isomack:
Isosorbide Dinitrate in Egypt.
List of Isomack substitutes (brand and generic names) | Sort by popularity |
| Unit description / dosage (Manufacturer) | Price, USD |
| Isolong (Israel, Lithuania) | |
| Capsule, Prolonged Release; Oral; Isosorbide Dinitrate 60 mg (Cti) | |
| IsoMack Retard (Kuwait, Paraguay) | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 120 mg | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 20 mg | |
| Capsule, Retard; Oral; Isosorbide Dinitrate 40 mg | |
| Isomak Retard (Egypt) | |
| ISONIT (Pakistan) | |
| ISONIT 20MG TABLET 1 strip / 10 tablets each (Johnlee (Vista)) | $ 0.34 |
| ISONIT 30MG TABLET SR 1 strip / 10 tablet srs each (Johnlee (Vista)) | $ 0.39 |
| ISONIT tab 10 mg x 10's (Johnlee (Vista)) | $ 0.24 |
| ISONIT tab 20 mg x 10's (Johnlee (Vista)) | $ 0.41 |
| Isonit 30mg Tablet SR (Johnlee (Vista)) | $ 0.04 |
| Isonitra 20sr | |
| Isopelet (Czech Republic, Slovakia) | |
| Isopit (Japan) | |
| Isopront (Portugal) | |
| Isorazsr 40 | |
| Isorbid (Mexico) | |
| Tablet; Oral; Isosorbide Dinitrate 10 mg (Pharos) | |
| Tablet; Sublingual; Isosorbide Dinitrate 5 mg (Pharos) | |
| Isorbid 10 mg x 100's (Pharos) | $ 10.23 |
| Isorbid 5 mg x 100's (Pharos) | $ 6.82 |
| Isorbid / amp 10 mg/10 mL x 10's (Pharos) | $ 81.84 |
| Isorbid AP (Mexico) | |
| Capsule, Enteric Coated; Oral; Isosorbide Dinitrate 20 mg | |
| Capsule, Enteric Coated; Oral; Isosorbide Dinitrate 40 mg | |
| Capsule, Enteric Coated; Oral; Isosorbide Dinitrate 60 mg | |
| Capsule, Enteric Coated; Oral; Isosorbide Dinitrate 80 mg | |
| Isorbide (Peru, United States) | |
| Isordil (Argentina, Australia, Costa Rica, Ethiopia, India, Kenya, Luxembourg, Netherlands, Oman, Philippines, South Africa, Sudan, Thailand, Turkey, United States, Venezuela, Zimbabwe) | |
| Capsule, Extended Release; Oral; Isosorbide Dinitrate 40 mg (IPCA Laboratories Ltd.) | |
| Tablet; Oral; Isosorbide Dinitrate 10 mg (IPCA Laboratories Ltd.) | |
| Tablet; Oral; Isosorbide Dinitrate 20 mg (IPCA Laboratories Ltd.) | |
| Tablet; Oral; Isosorbide Dinitrate 30 mg (IPCA Laboratories Ltd.) | |
| Tablet; Oral; Isosorbide Dinitrate 40 mg (IPCA Laboratories Ltd.) | |
| Tablet; Oral; Isosorbide Dinitrate 5 mg (IPCA Laboratories Ltd.) | |
| Tablet; Sublingual; Isosorbide Dinitrate 10 mg (IPCA Laboratories Ltd.) | |
| Tablet; Sublingual; Isosorbide Dinitrate 2.5 mg (IPCA Laboratories Ltd.) | |
| Tablet; Sublingual; Isosorbide Dinitrate 5 mg (IPCA Laboratories Ltd.) | |
| 100 tablet in 1 bottle (IPCA Laboratories Ltd.) | |
| Isordil 5mg SL-TAB / 100 (IPCA Laboratories Ltd.) | $ 0.25 |
| Isordil 10mg TAB / 100 (IPCA Laboratories Ltd.) | $ 0.53 |
| Isordil 10 mg x 100's (IPCA Laboratories Ltd.) | $ 19.80 |
| Isordil 5 mg x 100's (IPCA Laboratories Ltd.) | $ 17.70 |
| 10 mg x 100's (IPCA Laboratories Ltd.) | $ 0.53 |
| 5 mg x 100's (IPCA Laboratories Ltd.) | $ 0.25 |
| Isordil 5 mg Tablet (IPCA Laboratories Ltd.) | $ 0.01 |
See 751 substitutes for Isomack | |
References
- DailyMed. "ISOSORBIDE DINITRATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- PubChem. "ISOSORBIDE DINITRATE". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "ISOSORBIDE DINITRATE". http://www.drugbank.ca/drugs/DB00883 (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Isomack are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Isomack. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
Consumer reported useful
No survey data has been collected yetConsumer reported price estimates
No survey data has been collected yetConsumer reported time for results
No survey data has been collected yet1 consumer reported age
| Users | % | ||
|---|---|---|---|
| 46-60 | 1 | 100.0% | |
Consumer reviews
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Information checked by Dr. Sachin Kumar, MD Pharmacology
