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Evaluation was made on central hemodynamic effects of isosorbide dinitrate (ISDN) spray (Isomack spray<SUP>®</SUP>, Heinlich Mack Nachf., Germany) with special refference to the onset and duration of action compared to sublingual nitroglycerin and ISDN.<BR>In nine patients with uncomplicated acute myocardial infarction, ISDN spray (2 sprays, 2.5 mg), nitroglycerin (TNG, 0.3 mg) and ordinary ISDN tablet (5mg) were administered by single-blind cross-over method under hemodynamic monitoring with Swan-Ganz catheter. Systolic pulmonary artery pressure (s-PA), systolic blood pressure (s-BP) measured by sphyngomanometry and heart rate were measured. every one minute for 10 min, every 5 min for next 20 min and every 15 to 30 min thereafter up to 120 min. Using s-PA as an index for nitrate action, the onset and duration of the effect as well as the extent of the changes were compared among these three drugs.<BR>ISDN spary had quick onset of action (2.67±2.4min, mean±SD) which was comparable with TNG (2.67±1.00 min), while ISDN spray had long duration of action (57.4±42.1 min) which was comparable with sublingual ISDN (85.6±39.5, ns) and was significantly longer than TNG (11.4±6.4 min, P<0.05). ISDN spray (2.5mg) showed same extent of hemodynamic changes as 0.3 mg of TNG and 5 mg of ISDN. It is concluded that ISDN spray is a useful agent for the abortion of anginal attacks by its quick onset and long duration of action.