Effects of isosorbide dinitrate spray on central hemodynamics. Comparison with sublingual glyceryl trinitrate and isosorbide dinitrate.

Effects of isosorbide dinitrate (ISDN) spray (Iso Mack Spray) on central hemodynamics were determined in comparison to sublingual glyceryl trinitrate (nitroglycerin) and ISDN, paying particular attention to their onset and duration of action. In nine patients with uncomplicated acute myocardial infarction, ISDN spray (2 sprays, 2.5 mg) glyceryl trinitrate (TNG, 0.3 mg) and ordinary ISDN tablet (5 mg) were administered by the single-blind crossover method under hemodynamic monitoring with a Swan-Ganz catheter. Systolic pulmonary artery pressure (s-PA), systolic pressure (s-BP) and heart rate were measured every minute for 10 min, every 5 min for the subsequent 20 min and thereafter every 15 to 30 min up to 120 min. Using s-PA as a measure of nitrate action, the onset and duration of action as well as the magnitude of change was compared among the three drugs. ISDN spray had a quick onset of action (2.67 +/- 2.4 min, mean +/- SD) comparable to that of TNG (2.67 +/- 1.00 min), while ISDN spray had a long duration of action (57.4 +/- 42.1 min), which was comparable to that of sublingual ISDN (85.6 +/- 39.5 min, ns) and was significantly longer than that of TNG (11.4 +/- 6.4 min, p less than 0.05). ISDN spray (2.5 mg) showed the same hemodynamic changes as were induced by 0.3 mg TNG or 5 mg ISDN. The results of this study led us to conclude that ISDN spray is a useful agent which induces the abortion of anginal attacks by its quick onset and long duration of action.