isosorbide dinitrate

二硝酸イソソルビド

同

ISDN

WordNet

1. drug (trade name Isordil) used to treat angina pectoris and congestive heart failure (同)Isordil

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/10/30 13:30:25」(JST)

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Isosorbide dinitrate

Systematic (IUPAC) name
1,4:3,6-dianhydro-2,5-di-O-nitro-D-glucitol
Clinical data
AHFS/Drugs.com	monograph
Pregnancy cat.	C (US)
Legal status	℞ Prescription only
Routes	Oral
Pharmacokinetic data
Bioavailability	10–90%, average 25%
Metabolism	Hepatic
Half-life	1 hour
Excretion	Renal
Identifiers
CAS number	87-33-2
ATC code	C01DA08 C05AE02
PubChem	CID 6883
DrugBank	DB00883
ChemSpider	6619 Y
UNII	IA7306519N Y
KEGG	D00516 Y
ChEBI	CHEBI:6061 Y
Synonyms	(3R,3aS,6S,6aS)-hexahydrofuro[3,2-b]furan-3,6-diyl dinitrate
Chemical data
Formula	C6H8N2O8
Mol. mass	236.136 g/mol
SMILES [O-][N+](=O)O[C@H]1[C@H]2OC[C@H](O[N+]([O-])=O)[C@H]2OC1
InChI InChI=1S/C6H8N2O8/c9-7(10)15-3-1-13-6-4(16-8(11)12)2-14-5(3)6/h3-6H,1-2H2/t3-,4+,5-,6-/m1/s1 Y Key:MOYKHGMNXAOIAT-JGWLITMVSA-N Y
Y (what is this?)  (verify)

Isosorbide dinitrate (ISDN) (also known as Dilatrate) is a nitrate used pharmacologically as a vasodilator, e.g. in angina pectoris but also for anal fissure, a condition which is known to involve decreased blood supply leading to poor healing. It is also used as a direct vasodilator to treat congestive heart failure.

Isosorbide dinitrate is sold under the brand names Isordil by Biovail, Cedocard, Sorbitrate and Isotrate. In UK, Argentina and Hong Kong, a trade name of it is Isoket. It is also a component of BiDil.

Uses

It is more useful in preventing angina attacks than reversing them once they have commenced. It may be given as a tablet for the treatment of an angina attack.

Advantages

Long acting nitrates can be more useful as they are generally more effective and stable in the short term.

Disadvantages

After long term use for treating chronic conditions, tolerance may develop in a patient reducing its effectiveness. The mechanisms of nitrate tolerance have been thoroughly investigated in the last 30 years and several hypotheses have been proposed. These include:

1. Impaired biotransformation of ISDN to its active principle NO (or a NO-related species)
2. Neurohormonal activation, causing sympathetic activation and release of vasoconstrictors such as endothelin and angiotensin II which counteract the vasodilation induced by ISDN
3. Plasma volume expansion
4. The oxidative stress hypothesis (proposed by Munzel et al. in 1995).

Recent evidence suggests that the latter hypothesis might represent a unifying hypothesis, and an ISDN-induced inappropriate production of oxygen free radicals might induce a number of abnormalities which include the ones described above. Furthermore, studies have shown that nitrate tolerance is associated with vascular abnormalities which have the potential to worsen patients prognosis (Nakamura et al.): these include endothelial and autonomic dysfunction (Gori et al.). In the short run, ISDN can cause severe headaches, necessitating analgesic (very rarely up to morphine) administration for relief of pain as well as severe hypotension, and, in certain cases, bradycardia. This makes some physicians nervous and should prompt caution when starting nitrate administration.

References

UpToDate Contents

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• 1. 収縮能障害による心不全患者におけるヒドララジンおよび硝酸塩による治療 hydralazine plus nitrate therapy in patients with heart failure due to systolic dysfunction
• 2. 安定狭心症のマネージメントにおける硝酸塩 nitrates in the management of stable angina pectoris
• 3. 妊娠中絶の概要 overview of pregnancy termination
• 4. 心臓リモデリング：臨床的評価および治療 cardiac remodeling clinical assessment and therapy
• 5. 心不全患者における高血圧治療 treatment of hypertension in patients with heart failure

English Journal

• The effect of sublingual isosorbide dinitrate on acute urinary retention due to benign prostatic hyperplasia.

• Tadayyon F, Izadpanahi M, Aali S, Mazdak H, Khorrami MH.SourceDepartment of Urology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
• Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia.Saudi J Kidney Dis Transpl.2012 Jul;23(4):782-5.
• Acute urinary retention (AUR) is one of the most important long-term compli-cations of benign prostatic hyperplasia (BPH). Nitric oxide (NO) as a transmitter can relax smooth muscles of the bladder neck and external sphincter. Several studies have reported that sublingual isosorbide dinitrate (ISDN)
• PMID 22805391

• Is danshen (Salvia miltiorrhiza) dripping pill more effective than isosorbide dinitrate in treating angina pectoris? A systematic review of randomized controlled trials.

• Jia Y, Huang F, Zhang S, Leung SW.SourceInstitute of Chinese Medical Sciences, The University of Macau, Taipa, Macao SAR, China. gentrany@gmail.com
• International journal of cardiology.Int J Cardiol.2012 Jun 14;157(3):330-40. Epub 2011 Jan 19.
• BACKGROUND: Danshen dripping pill (DSP) is a popular Chinese medicinal product and often compared with isosorbide dinitrate (ISDN) in treating coronary heart disease angina pectoris. Over 100 randomized controlled trials (RCT) have been published in Chinese language but have not been evaluated accor
• PMID 21251721

Japanese Journal

• In vitro皮膚透過性研究におけるヒト皮膚に代わるラット皮膚の有用性

• TAKEUCHI Hiroyuki,MANO Yoko,TERASAKA Shuichi,SAKURAI Takanobu,FURUYA Atsushi,URANO Hidetoshi,SUGIBAYASHI Kenji
• Experimental animals 60(4), 373-384, 2011-07-01
• … In vitro permeation studies of the three model drugs, nicorandil, isosorbide dinitrate, and flurbiprofen, through human skin and SD rat skin were performed using Franz-type diffusion cells. …
• NAID 10029550710

• Nitric Oxide Radical-induced Radioadaptation and Radiosensitization are G2/M Phase-dependent

• SU Xiaoming,TAKAHASHI Akihisa,KONDO Natsuko,NAKAGAWA Yosuke,IWASAKI Toshiyasu,GUO Guozhen,OHNISHI Takeo
• Journal of Radiation Research advpub(0), 1107130217, 2011
• … H1299/wtp53 cells were pre-treated with isosorbide dinitrate (ISDN) at different concentrations or pre-irradiated with a low dose of X-rays, and then exposed to a high dose of X-rays. …
• NAID 130001021669

Related Links

• Isosorbide dinitrate - Wikipedia, the free encyclopedia

Isosorbide dinitrate (ISDN) (also known as Dilatrate) is a nitrate used pharmacologically as a vasodilator, e.g. in angina pectoris but also for anal fissure, a condition which is known to involve decreased blood supply leading to poor healing.

• Isosorbide Dinitrate (Oral Route, Sublingual Route) - MayoClinic.com

1 Jun 2012 ... Isosorbide dinitrate is used to prevent angina (chest pain) caused by coronary artery disease. It does not work fast enough to relieve the pain of an angina attack that has already started. Isosorbide dinitrate belongs to the ...

Related Pictures

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★リンクテーブル★

リンク元	「硝酸イソソルビド」「二硝酸イソソルビド」

「硝酸イソソルビド」

　　[★]

英

isosorbide dinitrate

同

二硝酸イソソルビド

商

硝酸イソソルビド、硝酸イソソルビドテープ、ニトラステープ、イソコロナールＲ、イソピットテープ、カリアントSR、ニトロールＲ、ニトロールスプレー、ニトロール、フランドルテープ、フランドル (2020/5/9)

Ｌ－オーネスゲン、アパティア、アンタップ、イソコロナール、イソピット、カリアントSR、サークレス、サワドール、ジアセラL、ニトラス、ニトロール、フランドル、リファタック、一硝酸イソソルビド、硝酸イソソルビド

関

一硝酸イソソルビド、血管拡張剤。硝酸薬

• 虚血性心疾患治療剤

分子式

• C6H8N2O8

薬効薬理

• 硝酸イソソルビドはニトログリセリン同様、構造中より一酸化窒素（NO）を放出し、細胞内cGMP量を増加させることで血管平滑筋を弛緩させる。その結果、心臓に対する前後負荷が軽減され、うっ血性心不全の血行動態が改善される。また、比較的太い冠動脈と共に側副血行路も拡張するため、冠血流量は増大する。静脈血管に選択性が高いが、血圧は下降する。効果発現はニトログリセリンより遅く、持続は長い。

適応

フランドルテープ

• 狭心症、心筋梗塞（急性期を除く）、その他の虚血性心疾患

• 狭心症の発作寛解を目的とした治療には不適であるので、この目的のためには速効性の硝酸・亜硝酸エステル系薬剤を使用すること。

禁忌

フランドルテープ

• 1. 重篤な低血圧又は心原性ショックのある患者

• 血管拡張作用により更に血圧を低下させ、症状を悪化させるおそれがある。

• 2. 閉塞隅角緑内障の患者

• 眼圧を上昇させるおそれがある。

• 3. 頭部外傷又は脳出血のある患者

• 頭蓋内圧を上昇させるおそれがある。

• 4. 高度な貧血のある患者

• 血圧低下により貧血症状（めまい、立ちくらみ等）を悪化させるおそれがある。

• 5. 硝酸・亜硝酸エステル系薬剤に対し過敏症の既往歴のある患者
• 6. ホスホジエステラーゼ5阻害作用を有する薬剤（シルデナフィルクエン酸塩、バルデナフィル塩酸塩水和物、タダラフィル）を投与中の患者

• 本剤とこれらの薬剤との併用により降圧作用が増強され、過度に血圧を低下させることがある。

添付文書

• フランドル錠20mg

http://www.info.pmda.go.jp/go/pack/2171011G1123_1_04/2171011G1123_1_04?view=body

• フランドルテープ40mg

http://www.info.pmda.go.jp/go/pack/2171700S1095_1_03/2171700S1095_1_03?view=body

「二硝酸イソソルビド」

　　[★]

英

isosorbide dinitrate, ISDN

関

硝酸イソソルビド、、ニトログリセリン

• 狭心症治療薬

• 硝酸薬

• 硝酸イソソルビド（しょうさんイソソルビド）は狭心症の治療薬として用いられる硝酸エステル製剤である。一般名として、ヒドロキシ基の1つが硝酸エステルとなっている誘導体を含む製剤である一硝酸イソソルビド（英 Isosorbide mononitrate, ISMN）と2つとも硝酸エステル化されている二硝酸イソソルビド（英 Isosorbide dinitrate, ISDN）があり、単に一般名で硝酸イソソルビドといった場合は後者（ビス硝酸エステル）を指す。

http://ja.wikipedia.org/wiki/%E7%A1%9D%E9%85%B8%E3%82%A4%E3%82%BD%E3%82%BD%E3%83%AB%E3%83%93%E3%83%89