Isosorbide dinitrate Intravenous Infusion for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

• See monitoring requirements below
• Adsorbs on to PVC- 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 pain relief, degree of headache and nausea

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 November 2018

Therapeutic classification

Nitrate drug