Isosorbide dinitrate Intravenous Infusion for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

  • See monitoring requirements below
  • Adsorbs on to PVC and PU (polyurethane)- see under Methods of intravenous administration and also Further information
  • For Y-site compatibility - see below

Available preparations

Isoket 10mg per 10ml (0.1%) ampoule

Reconstitution

Already in solution

Ampoule (10mg per 10ml)

  • Dilute further prior to administration
  • Draw up using a 5 micron filter needle

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Continuous intravenous infusion (administer using an electronically controlled infusion device)

  • Using 10mg per 10ml ampoule: Dilute 25mg (25ml) with 25ml infusion fluid (i.e.total volume 50ml, 0.5mg/ml) and administer at a rate adjusted according to response
  • The drug must be prepared in a syringe pump (as syringe pumps are low adsorption), and must be given via a low-adsorption giving set (e.g Braun Original Perfusor -Leitung PE 8723060 or Vygon Lectro-spiral 1155.80)

Bolus injection

  • Only for intracoronary use
  • Dose should be diluted with an equal volume of diluent

Dose in adults

Continuous intravenous infusion

  • A dose of 2 to 12mg per hour is suitable although doses as high as 20mg per hour may be necessary
  • Adjust according to patient's response.

Intracoronary (by bolus injection (dilute injection solution with an equal volume of diluent))

  • A dose of 1mg given as a bolus injection prior to balloon inflation.
  • Further doses may be given not exceeding 5mg within a 30 minute period.

Monitoring

  • Monitor pulse and blood pressure after each rate change and during administration
  • Monitor for headache, nausea and dizziness

Further information

  • The drug may be given as a large volume infusion (manufacturer's preferred method) -a low adsorption infusion bottle (eg Braun Ecoflac or Baxter Viaflo) must be used, and it must be given via a low adsorption giving set (Baxter VMC9606 or Braun 8700110SP)
  • However, in practice many patients are fluid restricted so this may not be practical

Storage

Store below 250C

References

Isoket 10mg per 10ml SPC January 2023

Therapeutic classification

Nitrate drug