isosorbide dinitrate

CLINICAL USE

Vasodilator:Prophylaxis and treatment of angina Left ventricular failure

DOSE IN NORMAL RENAL FUNCTION

Oral: Angina: 30–120 mg daily in divided —doses;LVF: 40– 240 mg daily —IV: 2–20 mg/hour depending on response

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :236.1

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :<1

%Excreted unchanged in urine &nbsp &nbsp :

10 to 20 &nbsp &nbsp :

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :2–4

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :0.5–1/–

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Dose as in normal renal function

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in normal renal function

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in normal renal function

HDF/high flux &nbsp :Unknown dialysability. Dose as in normal renal function

CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsSildenafil: hypotensive effect significantly enhanced – avoid concomitant useTadalafil: hypotensive effect significantly enhanced – avoid concomitant use

Vardenafil: hypotensive effect significantly enhanced – avoid concomitant use

ADMINISTRATION

Reconstition

–

Route

Oral,

IV infusion

Rate of Administration

1 mg/10 mL; 60 mL/hour ≡ 6 mg/hour2 mg/10 mL; 30 mL/hour ≡ 6 mg/hour

Comments

Dilute using sodium chloride 0.9% or glucose 5% to 1 mg/10 mL or 2 mg/10 mL; final volume 500 mLUse of PVC giving sets and containers should be avoided since significant losses of the active ingredient by absorption can occur

OTHER INFORMATION

Isosorbide dinitrate undergoes extensive first pass metabolism, mainly in the liver; major metabolites are isosorbide-2-mononitrate and isosorbide-5-mononitrateBoth metabolites possess vasodilatory activity and may contribute to the activity of the parent compoundBoth metabolites have longer half-lives than the parent compound

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