Last update Feb. 2, 2024

Isosorbide Dinitrate

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Isosorbide dinitrate is a vasodilator used in the treatment of angina pectoris and heart failure. It has general properties similar to those of glyceryl trinitrate or nitroglycerin. Its active metabolite is isosorbide mononitrate. Sublingual, oral, transdermal or intravenous administration.

At the time of the last update, we found no published data on its excretion in breast milk.

Its pharmacokinetic data (large volume of distribution and short half-life) (Kirsten 1998) make it unlikely to pass into breast milk in clinically significant quantities.

Its low oral bioavailability makes it difficult to pass into infant plasma from ingested breast milk, except in premature infants and the immediate neonatal period where there may be greater intestinal permeability.

If used during breastfeeding, it is advisable to monitor the infant for symptoms of drowsiness, lethargy or poor feeding and to monitor for weight gain. (Kearney 2018)

The amount of nitrate/nitrite in breast milk is not related to the level of nitrate ingested by the mother in water, food or medications (Paszkowski 1989). Ingestion of up to 100 mg/day of nitrate does not increase nitrate levels in breast milk. (Dusdieker 1996). For this reason, breastfed infants from regions with nitrate-contaminated water do not have an increased risk of methemoglobinemia, in contrast to bottle-fed infants. 

The amount of nitrate compounds contained in vasodilator drugs is so small that no nitrate toxicity problems, such as methemoglobinemia, have been reported in breastfed infants whose mothers used them.

Alternatives

We do not have alternatives for Isosorbide Dinitrate.

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Isosorbide Dinitrate in other languages or writings:

Tradenames

Main tradenames from several countries containing Isosorbide Dinitrate in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. oral 22. sublingual 45 %
Molecular weight 236 daltons
Protein Binding 28 %
VD 3.9 l/Kg
Tmax sublingual 0.25. oral 0.5 hours
1 Metabolit: 5 hours

References

  1. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev. 2018 Abstract Full text (link to original source) Full text (in our servers)
  2. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  3. Dusdieker LB, Stumbo PJ, Kross BC, Dungy CI. Does increased nitrate ingestion elevate nitrate levels in human milk? Arch Pediatr Adolesc Med. 1996 Mar;150(3):311-4. Abstract
  4. Paszkowski T, Sikorski R, Kozak A, Kowalski B, Jakubik J. [Contamination of human milk with nitrates and nitrites]. Pol Tyg Lek. 1989 Nov 13-27;44(46-48):961-3. Polish. Abstract

Total visits

9,103

Help us improve this entry

How to cite this entry

Do you need more information or did not found what you were looking for?

   Write us at elactancia.org@gmail.com

e-lactancia is a resource recommended by El Parto Es Nuestro of Spain

Would you like to recommend the use of e-lactancia? Write to us at corporate mail of APILAM