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 120-150mmHg 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.