ISOSORBIDE DINITRATE injectable

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    Last updated: August 2021

     

    Prescription under medical supervision

     

    Therapeutic action

    • Vasodilator, antianginal

    Indications

    • Adjunctive therapy in acute heart failure (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

    Dosage

    • Adult: 2 mg (= 2 ml) by slow IV injection (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 the systolic pressure to 120-150 mmHg and the 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, haemolytic anaemia in patients with G6PD deficiency;
      • severe hypotension with risk of circulatory collapse in the event of overdose.
    • Avoid combination or use the lowest effective dose in patients taking another nitrate derivative, a vasodilator, a diuretic or an antihypertensive drug (enhances hypotensive effects), and in older patients. 
    • Do not combine with sildenafil or other drugs used for erectile dysfunction (risk of severe hypotension, syncope and acute coronary syndrome).
    • Pregnancy and breast-feeding: avoid, use only if clearly needed (safety not established)

    Remarks

    • Injectable isosorbide dinitrate is not included in the WHO list of essential medicines.

    Storage

    Below 25 °C