How should oral isosorbide dinitrate dosage be initiated in heart failure treatment?

For initiating oral isosorbide dinitrate in the treatment of heart failure, the recommended starting dosage is indeed 15 mg taken twice daily. This dosage is effective in providing the necessary vasodilatory effects without an excessive risk of side effects such as hypotension or headache, which can occur with higher doses.

Lower starting doses may not achieve the desired therapeutic effects. While the other options represent various dosages, they do not align with clinical guidelines for optimal initiation of therapy. Starting at 5 mg once daily may be insufficient for therapeutic efficacy, and much higher doses like 30 mg three times daily or 60 mg once daily present an increased risk for adverse effects, especially in patients who might be sensitive to nitrates. Thus, the 15 mg twice daily regimen is established as a balanced approach in managing heart failure symptoms effectively.