Isosorbide dinitrate has documented advantages for angina pectoris: buccal applications (chewing capsules, spray, tablets) can stop seizures almost as dependently as glyceryl trinitrate. For the prevention of chronic seizures oral sustained release preparations are best suited; they are generally equally as or more efficacious than calcium-channel blocking agents. A combination with the latter is possible. For unstable angina pectoris, ISDN can be administered intravenously (as an alternative to glyceryl trinitrate).

Isosorbide dinitrate is also suitable for the treatment of heart failure. In combination with the vasodilator hydralazine, it has proven to be life-prolonging in a large study involving men with chronic heart failure.

Even though ISDN's most important metabolite isosorbide-5-mononitrate is now available as a drug, many specialists still prefer the dinitrate. The mononitrate may produce the same effects, but all the important studies have so far been carried out with ISDN.

The relaxation of the smooth muscle produced by the nitrates may also be useful for esophageal spasm and achalasia.

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