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Imdur vs Isordil
Introduction
For patients with angina or chest pain, certain drugs that alter the balance of oxygen and blood flow to the heart can help in managing symptoms and preventing attacks. Imdur (isosorbide mononitrate) and Isordil (isosorbide dinitrate) are two such medications prescribed for this purpose. Both belong to a class of drugs called nitrates which work by relaxing and widening blood vessels, thus allowing better blood flow to the heart muscle. While their mode of action is similar, they do differ in how they are metabolized by the body. Imdur is an extended-release tablet providing a steady level of medication throughout the day, while Isordil tablets may need to be taken more frequently as their effect tends to wear off sooner.
Imdur vs Isordil Side By Side
| Attribute | Imdur | Isordil |
|---|---|---|
| Brand Name | Imdur | Isordil |
| Contraindications | Cannot be taken with ED medications like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) due to risk of severe hypotension | Cannot be taken with ED medications like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) due to risk of severe hypotension |
| Cost | Generic ranges from about $0.40 to $1.20 per day | Generic starts as low as $.20/day and typically does not exceed about $.80/day |
| Generic Name | Isosorbide Mononitrate | Isosorbide Dinitrate |
| Most Serious Side Effect | Bluish-colored lips, fingernails, and palms; blurred or loss of vision; chest pain or discomfort; dizziness or faintness when getting up suddenly from a lying position | Severe skin reaction: fever, sore throat, swelling in your face or tongue, burning eyes, skin pain followed by a red or purple skin rash that spreads and causes blistering and peeling |
| Severe Drug Interactions | Severe hypotension when combined with ED medications | Severe hypotension when combined with ED medications |
| Typical Dose | 30-60 mg/day, up to a maximum of 240 mg/day based on patient response | 5–20 mg taken by mouth three to four times daily, up to 40 mg per dose |
What is Imdur?
Isosorbide mononitrate (the generic name for Imdur) was a significant advancement from its predecessor, isosorbide dinitrate (Isordil). Both medications belong to the class of drugs known as nitrates and are used to treat angina pectoris. Isosorbide mononitrate was first approved by the FDA in 1991. Imdur primarily functions by relaxing and widening blood vessels so that blood can flow more easily to the heart, effectively reducing chest pain occurrences. It is commonly prescribed for long-term management of chronic stable angina. Unlike Isordil, which needs to be taken multiple times a day due to its short half-life, Imdur is typically administered once daily owing to its longer half-life. This results in it having better patient compliance with fewer dosing-related inconveniences than Isordil.
What conditions is Imdur approved to treat?
Imdur and Isordil are used for the management of different cardiac-related conditions:
- Angina pectoris, also known as chest pain or discomfort due to coronary heart disease. Both medications are approved for this indication.
- Prophylactic treatment in situations likely to provoke angina attacks, such as physical exertion or emotional stress. Imdur is commonly prescribed for this use.
- Heart failure associated with acute myocardial infarction. Isordil is typically utilized for this purpose.
How does Imdur help with these illnesses?
Imdur helps to manage angina (chest pain) by increasing the amount of nitric oxide in the smooth muscle cells lining blood vessels. It does this by releasing nitric oxide as it is metabolized in these cells, causing them to relax and dilate. Nitric oxide is a signaling molecule that plays an important role in various physiological processes such as regulating vascular tone, inhibiting platelet aggregation, and modulating inflammation. In individuals with angina pectoris, their coronary arteries may not be able to deliver enough oxygen-rich blood to the heart especially during exertion which leads to chest pain or discomfort known as angina. Therefore, by increasing nitric oxide availability and inducing vasodilation, Imdur can help limit anginal episodes and improve patients' quality of life.
What is Isordil?
Isordil is a brand name for the drug isosorbide dinitrate, which works as a vasodilator. By relaxing and widening blood vessels, it increases the supply of blood and oxygen to the heart while reducing its workload. This makes Isordil particularly beneficial in managing conditions like angina (chest pain). It first gained approval by the FDA in 1960.
As an organic nitrate compound, Isordil does not prevent chest pain from occurring but can relieve it once it starts or if taken beforehand, may prevent an angina episode. Unlike Imdur (isosorbide mononitrate), another medication used for similar purposes but with a different metabolic pathway, Isordil's effect tends to diminish after repeated use due to tolerance development. Therefore, patients usually have "nitrate-free" periods each day where they take no medication so that they can maintain their sensitivity.
Its side effects differ from other types of medications because it doesn't affect neurotransmitters like serotonin or dopamine; instead potential side effects include lightheadedness or fainting due to reduced blood pressure.
What conditions is Isordil approved to treat?
Isordil, a form of isosorbide dinitrate, is approved by the FDA for the prevention and treatment of angina pectoris due to coronary artery disease. The specific conditions it's used for include:
- Angina pectoris prophylactic therapy
- Acute heart failure
- Chronic heart failure
It works by relaxing and widening blood vessels so blood can flow more easily to the heart.
How does Isordil help with these illnesses?
Nitric oxide is a vasodilator which helps in relaxing the smooth muscle cells within vessel walls, leading to dilation and increased blood flow. Isordil works by increasing levels of nitric oxide in the body, thereby easing chest pain caused by angina. It does this by dilating (widening) the arteries and veins in the body. This reduces the workload on your heart and aids in relieving symptoms of attacks when they occur.
While Imdur also functions similarly, it has more sustained effects than Isordil but may not provide immediate relief during an acute angina episode. Therefore, Isordil can be chosen either as a preventive medication for chronic stable angina or used sublingually for immediate effect during an active episode. As with any cardiovascular drug regimen changes though, such decisions should always involve consultation with one's healthcare provider.
How effective are both Imdur and Isordil?
Both Isosorbide mononitrate (Imdur) and Isosorbide dinitrate (Isordil) are well-established medications used to treat angina pectoris (chest pain), a symptom of coronary artery disease. They were initially approved by the FDA in 1987 and 1965 respectively, with Imdur being the later developed mono-nitrate derivative of isosorbide dinitrate. Both drugs work by relaxing blood vessels and increasing the supply of blood and oxygen to the heart while reducing its workload, but they vary slightly in their pharmacokinetics.
The effectiveness of both drugs has been validated through numerous studies over years. A key difference lies in that isosorbide mononitrate's longer half-life allows for once daily dosing as opposed to multiple doses needed with isosorbide dinitrate which can increase patient compliance. Despite this advantage, some patients respond better to one drug than another due to individual differences such as tolerance development or side effects profile which includes headache, flushing, lightheadedness or low blood pressure.
A comprehensive review on long-acting nitrates published in Cardiovascular Therapeutics in 2012 noted that despite the convenience offered by Imdur’s once-daily dosing schedule compared with Isordil's two- or three-times-a-day regimen, there was no significant difference between them regarding anti-ischemic efficacy when given at equivalent nitrate doses.
While both medications have proven effective for managing angina symptoms throughout their decades-long history of use, it ultimately comes down to individual patient characteristics including response rate and personal preference regarding dose frequency when choosing between these two treatment options.
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At what dose is Imdur typically prescribed?
Oral dosages of Imdur typically start at 30-60 mg/day, but studies have indicated that a daily dosage of 60 mg is usually sufficient for preventing angina pectoris in most patients. It may be increased to 120 mg/day if response isn't adequate after several weeks. In rare cases, the dose can be upped to a maximum of 240 mg/day based on individual patient response. On the other hand, Isordil is usually prescribed in an initial oral dose of 5–20 mg every four to six hours; however, some patients might require higher doses. Dosage can be gradually increased over time depending on the patient's tolerance and response, but should not exceed a maximum dosage of 160 mg/day.
At what dose is Isordil typically prescribed?
Isordil, also known as Isosorbide Dinitrate, is typically initiated at a dose of 5–20 mg taken by mouth three to four times daily. The dosage can then be increased up to 40 mg per dose if the lower dosages are ineffective in managing angina symptoms. Each dose should be evenly spaced throughout the day with an interval of at least six hours between doses. If there's no improvement in your symptoms after consistent use at this level for several weeks, seek further consultation from your doctor about potential treatment adjustments or alternatives.
What are the most common side effects for Imdur?
Common side effects of Imdur and Isordil, both medications that are used to treat angina (chest pain), may include:
- Headache
- Dizziness or lightheadedness
- Flushing (warmth, redness, or tingly feeling under your skin)
- Nausea, vomiting
- Low blood pressure which can cause fainting
- Weakness or fatigue
- Rapid heart rate (tachycardia)
- Angina pectoris aggravated (worsening chest pain)
- Rash
- Restlessness
If any of these symptoms persist or worsen over time, it is recommended to seek medical attention promptly. Always remember that while the above lists common side effects associated with these medications, not all individuals will experience them.
Are there any potential serious side effects for Imdur?
While both Imdur and Isordil are used to prevent chest pain (angina), there can be differences in side effects. For Imdur, certain serious side effects may occur such as:
- An allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Bluish-colored lips, fingernails and palms
- Blurred or loss of vision
- Chest pain or discomfort
- Dizziness or faintness when getting up suddenly from a lying position.
For Isordil on the other hand:
- Signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat
- Unusually weak or tired feelings
- Flushing (warmth/redness) in the facial area. Severe hypotension - severe dizziness/weakness/lightheadedness upon standing up
If you experience any symptoms listed above while taking either medication it's crucial to seek immediate medical attention.
What are the most common side effects for Isordil?
Isordil, like Imdur, is used to prevent chest pain (angina) in patients with a certain heart condition (coronary artery disease). However, Isordil can cause some different side effects:
- Dry mouth
- Flushing and sweating
- A sensation of whirling or loss of balance (dizziness)
- Headache
- Nausea and vomiting
- Weakness and fatigue
- Rapid heartbeat (tachycardia) Although less common, severe side effects may include:
- Allergic reactions such as rash or itching
- Severe dizziness and fainting.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of these side effects. Many people using this medication do not have serious side effects.
Are there any potential serious side effects for Isordil?
Isordil, while effective at treating and preventing chest pain (angina), may cause serious side effects in rare instances. These could include:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat
- A severe skin reaction: fever, sore throat, swelling in your face or tongue burning eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
- Lightheadedness like you might pass out
- Fast heartbeats
- New or worsening chest pain
- Worsening angina pain
- Pounding heartbeats
If you notice any of these symptoms after starting Isordil treatment it is recommended to discontinue its use immediately and contact your healthcare provider for further advice.
Contraindications for Imdur and Isordil?
Both Imdur and Isordil, along with any other nitrate medications, may exacerbate symptoms of low blood pressure in some people. If you notice your blood pressure dropping excessively or experience severe dizziness, fainting spells, or an unusually fast heartbeat while taking either medication, please seek immediate medical attention.
Neither Imdur nor Isordil can be taken if you are using medications for erectile dysfunction (ED) like sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), etc., as the combination could lead to a serious drop in blood pressure. Always inform your physician about all the medications and supplements you are currently taking; ED drugs will require a period of at least 24 hours to clear from your system before starting treatment with nitrates such as Imdur or Isordil to prevent dangerous interactions.
How much do Imdur and Isordil cost?
For the brand name versions of these drugs:
- The price for a pack of 30 tablets of Imdur (60 mg) averages around $160, which works out to approximately $5.33/day.
- The price for a box of 100 tablets of Isordil (10 mg) is about $130, resulting in roughly $1.30/day.
Thus, if you are on an equivalent dosage range for both medications (considering Isosorbide dinitrate's shorter half-life), then brand-name Isordil could be less expensive on a per-day treatment basis. However, it's crucial to remember that cost should not be your primary consideration in determining which drug is right for you.
For the generic versions:
- Generic Imdur (isosorbide mononitrate) ranges from about $0.40 to $1.20 per day depending upon your dose and where you purchase it.
- Generic Isordil (isosorbide dinitrate), available in packs starting at 50 tablets up to several hundred, can start as low as $.20/day and typically does not exceed about $.80/day.
Worth noting: this comparison assumes twice daily dosing with isosorbide dinitrate due to its shorter half-life compared to once-daily dosing with isosorbide mononitrate. Always consult your doctor or pharmacist when deciding between medicines like these; there may be specific reasons one would work better than another based on individual factors beyond just cost alone.
Popularity of Imdur and Isordil
Isosorbide mononitrate, also known by brand names such as Imdur, was estimated to have been prescribed to about 8 million people in the US in 2020. Isosorbide mononitrate accounted for just over 15% of prescriptions given for angina pectoris (chest pain or discomfort due to coronary heart disease). This medication relaxes and widens blood vessels so that blood can flow more easily to the heart.
On the other hand, isosorbide dinitrate, including brand versions such as Isordil, was prescribed to approximately 2 million people in USA in 2020. In America, isosorbide dinitrate accounts for just under 5% of nitrate prescriptions used primarily for treating and preventing angina attacks. The prevalence of isosorbide dinitrate has remained fairly steady over the past decade. Both medications are nitrates which work similarly but are taken differently: Imdur is typically taken once a day while Isordil may be taken multiple times a day.
Conclusion
Both Imdur (isosorbide mononitrate) and Isordil (isosorbide dinitrate) are frequently used in the treatment of angina pectoris, a type of chest pain caused by decreased blood flow to the heart. They help by relaxing and widening blood vessels, thus allowing for better blood flow. Their efficacy is well-established through years of clinical use supported by extensive research.
Sometimes these drugs may be used together but it's important to consider their pharmacokinetics: Isordil has an immediate onset while Imdur provides more sustained relief due to its longer half-life. Therefore, they might be prescribed under different circumstances; with Isordil often employed for acute angina attacks or prevention before physical activity, whereas Imdur tends to be regularly used for long-term management.
Both medications are available as generics which can offer significant cost savings especially if you're paying out-of-pocket. It should also be noted that both drugs require a titration period during which optimal dosage is established gradually.
Side effects between these two medications are similar; common ones include headache, lightheadedness and flushing. However, some patients find that side effects like headaches lessen over time with continued usage of Imdur due to its sustained-release nature. As always when starting new medication regimes, patients should closely monitor their symptoms and consult their healthcare provider if any concerns arise.
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Refrences
- Gunasekara, N. S., & Noble, S. (1999). Isosorbide 5-Mononitrate. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-199957020-00016
- Seabra-Gomes, R., Aleixo, A. M., Adao, M., Machado, F. P., Mendes, M., Bruges, G., & Palos, J. L. (1990, June). Comparison of the effects of a controlled-release formulation of isosorbide-5-mononitratt and conventional isosorbide dinitrate on exercise performance in men with stable angina pectoris. The American Journal of Cardiology. Elsevier BV.http://doi.org/10.1016/0002-9149(90)91318-z
- Rehnqvist, N., Nyberg, G., Carlens, P., Lindström, E., Lundman, T., Nordlander, R., … Åström, H. (1987). Mononitrates as Monotherapy in the Prophylactic Treatment of Angina Pectoris. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-198700334-00018
- Uusitalo, A. (1987). Long Term Efficacy of a Controlled-Release Formulation of Isosorbide 5-Mononitrate (Imdur®) in Angina Patients Receiving β-Blockers. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-198700334-00020