ISOSORBIDE DINITRATE injectable

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-feedingavoid, 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