You or someone in your family may have been given a small tablet to put under your tongue by your doctor for chest pain. This is often called ISDN. There are a few things to be aware of when using this medicine, which is given to treat sudden chest pain, or angina. Today, we'll talk about how to use this medicine, what the possible side effects are, and what you need to pay special attention to.
What really happens with this medicine?
Simply put, ISDN (Isosorbide Dinitrate) is a nitrate-type vasodilator drug. Imagine that the blood vessels that carry blood to our heart are a little narrowed. What this drug does is temporarily widen those vessels. This increases the amount of blood and oxygen flowing to the heart.
Angina is a chest pain that occurs when the heart does not get enough oxygen. This medicine works by restoring that oxygen supply and reducing chest pain. It is used in two main ways:
- To prevent chest pain: You can use this before doing strenuous activities, such as climbing stairs, to prevent pain.
- To treat chest pain that has already occurred: If chest pain has already occurred, this medicine is also used to relieve it.
What should I tell the doctor before taking this medicine?
Before you are prescribed this medication, it is important to tell your doctor this information, as it is very important for your safety.
- Low blood pressure: If you have low blood pressure.
- Heart disease history: If you have had a heart attack before, or if you have heart failure.
- Allergies: If you are allergic to isosorbide dinitrate, other nitrates, any other medicine, food, dyes, or preservatives.
- Pregnancy and breastfeeding: If you are pregnant, trying to get pregnant, or breastfeeding.
How should I use this medicine?
The way you use this medicine is very important. Follow the doctor's instructions exactly.
This pill is not meant to be swallowed. It should be kept under the tongue. Then it will dissolve directly and be absorbed into the bloodstream. We call this method 'sublingual'.
- Do not chew, crush, or break: Place the tablet completely under the tongue and let it dissolve.
- When to use: You can use this about 15 minutes before doing something that you think might cause chest pain (for example, climbing stairs, lifting weights). Or, use it as soon as you feel chest pain, as directed by your doctor.
- Dosage: Do not take more than the number of times prescribed by your doctor.
- For children: If giving this medicine to children, talk to a pediatrician about it. Special care may be needed.
What if you take too much medicine? (Overdose)
If you think you have taken too much of this medicine, immediately call the National Poisons Information Centre at the Colombo National Hospital, or go to the Emergency Department (ETU) of the nearest hospital. Treat this as an emergency.
What if I miss a dose of medication?
If you miss a dose, take it as soon as you remember. But if it is almost time for your next dose, skip the missed dose and take your next dose at the scheduled time. Never take a double dose.
Other things that may interact with this medicine
When taking this medicine, it can interact with some other medications and things, so you need to be especially aware of this.
| Interactions with ISDN | |
|---|---|
| Never take ISDN with these medications. | |
| Medications used for erectile dysfunction (ED) | For example: Sildenafil, Tadalafil, Vardenafil. Taking these together can cause a dangerous drop in blood pressure. |
| Riociguat | (A medicine for pulmonary hypertension) |
| If you are taking ISDN with these, inform your doctor and be very careful. | |
| Alcohol | Increases dizziness and decreased blood pressure. |
| Other medications for high blood pressure | Blood pressure may drop unnecessarily. |
| Other medications taken for angina or heart failure | Take only on the advice of a doctor. |
This list is not complete. Tell your doctor about all the medications, vitamins, herbs, and supplements you take. Also, be sure to tell your doctor if you smoke or drink alcohol.
Things to keep in mind while taking the medicine
- Dizziness and lightheadedness: This medicine may make you feel dizzy. So avoid driving, using machinery, and doing other activities that require alertness until you know how this medicine affects you. To reduce dizziness and lightheadedness, do not get up from a sitting or standing position suddenly. Take your time.
- Alcohol: Drinking alcohol can make dizziness worse. So avoid alcohol completely.
- Other medicines: While you are taking this medicine, do not take any over-the-counter medicines for cough, cold, or pain without first asking your doctor. Some medicines contain ingredients that can increase your blood pressure.
- If the medicine is not working: If you feel like the medicine is not working as well as it used to, tell your doctor.
What are the possible side effects?
Like any medication, ISDN can cause some side effects.
| Possible side effects of ISDN | |
|---|---|
| If these symptoms occur, notify your doctor immediately. | |
| Blue discoloration of the lips, fingernails, or palms | This may be a sign of low oxygen levels in the blood (cyanosis). |
| Irregular heartbeat, feeling like your chest is pounding (palpitations) | Heart function may be affected. |
| Low blood pressure (dizziness, fainting) | It could be a sign of an overdose. |
| Persistent severe headache | Although this is a common side effect, please report it if it is severe. |
| Feeling unusually tired or weak | It may be due to low blood pressure. |
| Nausea, vomiting | If it persists, inform the doctor. |
| Things that are usually not serious, but should be reported to the doctor if they persist | |
| Flushing of the face or neck | A temporary condition caused by dilation of blood vessels. |
| Skin rash | It could be a sign of an allergy. |
This list does not include all possible side effects. If you experience anything different, please contact your doctor for medical advice.
How should you store your medicine?
- Keep this medicine out of the reach of children .
- Store at room temperature (about 25 degrees Celsius).
- Protect from light. Keep the medicine bottle/packet tightly closed.
- Discard expired medication without using it.
Take-Home Message
- ISDN (Isosorbide Dinitrate) is a sublingual medicine used to treat chest pain (Angina). Never swallow it.
- While taking this medication, never take medications for erectile dysfunction, such as Sildenafil (Viagra). It can cause a dangerous drop in blood pressure.
- You may feel dizzy after taking the medicine, so be careful when driving or doing anything that requires concentration. Avoid drinking alcohol.
- Be sure to tell your doctor about any other illnesses you have, any other medications you are taking, and any side effects you are experiencing.
- If you take too much medicine, immediately call the National Poisons Information Centre at the National Hospital or go to the nearest ETU (Emergency Treatment Unit) .
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