Isosorbide Dinitrate Injectable: Dosing and Precautions

Therapeutic action

Vasodilator, antianginal.

Indications

Adjunctive therapy in acute heart failure with acute pulmonary oedema.

Forms and strengths, route of administration

• 10 mg in 10 ml ampoule (1 mg/ml) for slow IV injection or IV infusion in 5% glucose or 0.9% sodium chloride.

Dose

• Adult: 2 mg (2 ml) by slow IV injection over 2 minutes then, if necessary, 2 to 10 mg/hour by continuous infusion with an electric syringe pump.
• Monitor blood pressure during administration.
• The objective is to lower systolic pressure to 120 to 150 mmHg and diastolic pressure to under 110 mmHg.

Contra-indications, adverse effects, precautions

• Do not administer to patients with obstructive cardiomyopathy, hypotension, shock, intracranial hypertension, or neurologic injury.
• May cause orthostatic hypotension, especially in older patients, headache, nausea, flushing of the face, and haemolytic anaemia in patients with G6PD deficiency.
• Severe hypotension with risk of circulatory collapse may occur in overdose.
• Avoid combination or use the lowest effective dose in patients taking another nitrate derivative, a vasodilator, a diuretic, or an antihypertensive drug, and in older patients.
• Do not combine with sildenafil or other drugs used for erectile dysfunction.
• Pregnancy and breast-feeding: avoid, use only if clearly needed.