QUESTION:
I'm currently taking 90mg of isosorbide dinitrate every 4.5 hours for angina (450+ mg/day). The maximum recommended dosage is 240 mg/day. I'm thinking of increasing my dosage to 120mg hoping to extend its effects. How long would it need to be effective in order to justify the additional 30mg.
I need to be very careful here, because this involves cardiac medication at a very high dose, and changing it on your own could be dangerous.
Short answer (important)
Increasing isosorbide dinitrate from 90 mg to 120 mg is very unlikely to meaningfully extend its duration of action, and it significantly increases the risk of side effects (low blood pressure, dizziness, syncope, reflex tachycardia). Dose escalation does not reliably overcome nitrate tolerance, which is usually the limiting factor—not insufficient milligrams.
You should not change this dose without your cardiologist’s explicit guidance.
Why a higher dose usually doesn’t “last longer”
1. Pharmacokinetics
Once hepatic metabolism and vasodilatory pathways are saturated, extra drug mostly increases side effects, not therapeutic time.
2. Nitrate tolerance is the key issue
When nitrates are given frequently or continuously, the body rapidly becomes tolerant:
That’s why standard nitrate regimens include a daily nitrate-free interval of 10–14 hours.
Your schedule of every 4.5 hours suggests tolerance may already be playing a role.
What would “justify” an extra 30 mg — in theory
From a pharmacologic standpoint, an additional 30 mg would only be justified if it:
In practice, studies and clinical experience show:
Specific risks at 120 mg per dose
At that level, concerns include:
What cardiologists usually consider instead
If angina control is inadequate at high-dose dinitrate, clinicians typically consider:
Please don’t adjust this alone
Given the dose and frequency you’re already on, this is well beyond a “minor tweak.”
The right next step is a cardiology discussion, not a self-trial.
If you want, I can help you:
Just tell me how you’d like to proceed.
I subscribed to the Lib of Congress nwsltr. They sent this article which includes the link to the (1.5 hr long / below) video.
Eventually I getz fed up stayin' up all night and tooken a whole ambien. The next day is loggy and includes a nap, typically an hour and a half in the late afternoon.
The nap easily carries me through until 5 a.m., maybe longer, depending on how exciting The Mkt is. Pre-Mkt opens at 2 a.m. and needs frequent checking.
The REAL Mkt opens at 7:30 a.m. and goes until 2 p.m. Having awakened at 4 pm the day before, we're now at 22 hours. Now, half an ambien is sufficient.
So far this month I've made $300.00. Nothing near my goal of $40k+/mo, but I'm humming that song about rubber tree plants.
Anyway, around 10:30 I started reading Shamans of the World edited by Nancy Connor with Bradford Keeney, Ph.D. and - you know how it is w the internet - now, at 1:22 a.m. Monday, here's the warren so far:
Here's Walking Thunder. Shamans starts w her, a Diné.
