Isosorbide
ISMOTIC
What it isOsmotic agent given orally; acute angle-closure glaucoma.
Why this oneIt lowers intraocular pressure without the sodium load of mannitol, and is usable in diabetes unlike glycerin.
What limits itOsmotic diarrhea and nausea. Distinct from isosorbide dinitrate and mononitrate — a dangerous name overlap.
FDA-approved for
- acute reduction of intraocular pressure
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Angina pectoris (prophylaxis) | Adults | 5-20 mg BID-TID | 10-40 mg BID-TID |
Renal Undefined
Hepatic Undefined
Daily dose-free interval ≥14 h required to prevent tolerance; expect ≤~12 h anti-anginal efficacy per day
Instructions
- Provide a daily nitrate-free interval of ≥14 h to minimize tolerance
- Administer the minimum dose that produces the desired effect
Contraindications
- Concurrent PDE5 inhibitors (sildenafil, tadalafil, vardenafil) — severe hypotension
- Concurrent riociguat (guanylate cyclase stimulator) — hypotension
Cautions
- Headache (common, dose-related, may be severe)
- Hypotension/lightheadedness
- Tolerance with continuous 24-h exposure
- Rare methemoglobinemia
- Syncope, crescendo angina, rebound hypertension (uncommon)
Adverse reactions
- Headache
- Lightheadedness
- Hypotension
- Syncope
- Rebound hypertension (uncommon)
Pregnancy Pregnancy Category C; dose-related embryotoxicity in animals at high doses; use only if benefit justifies risk.
Lactation Undefined
NO BOXED WARNINGS
Principal riskOsmotic diarrhea and nausea
Classes and tags
Clinical profile
Mechanism of action: Isosorbide ballicule
Open Isosorbide in the interactive console ↗
Memory aids: mascots and interaction avatars
osmotic diuretic, not to be confused with nitrate vasodilators
decreases serum lithium
