Isoket is a peripheral vasodilator with antianginal effect.
Release form and composition
Isoket produced in the form:
- Dosed spray (in dark glass bottles of 15 ml, designed for 300 doses);
- The concentrate from which the solution is prepared for infusions (in 10 ml ampoules).
1 spray dose contains:
- 1.25 mg isosorbide dinitrate;
- Ethanol 100% and macrogol 400 as auxiliary components.
1 mg of concentrate contains:
- 1 mg of isosorbide dinitrate;
- Additional substances: hydrochloric acid 1M (up to pH 5.0-7.0), sodium chloride, sodium hydroxide solution 2M, water for injection.
Indications for use
Intravenous izoket prescribed for:
- Acute left ventricular failure;
- Heart failure of various origins;
- Unstable angina pectoris;
- Acute myocardial infarction, accompanied by left ventricular failure.
In the form of a dosed spray, the drug is prescribed:
- For the relief of strokes;
- For the prevention of strokes before impending physical or emotional stress;
- In acute myocardial infarction, including complicated acute left ventricular failure;
- After myocardial infarction.
Isoket is contraindicated in:
- Constrictive pericarditis;
- Cardiac tamponade;
- Severe arterial hypotension (if systolic blood pressure is less than 90 mm Hg and diastolic blood pressure is less than 60 mm Hg);
- Coronary heart disease;
- Primary pulmonary diseases;
- Toxic pulmonary edema;
- Hypertrophic obstructive cardiomyopathy;
- Acute conditions accompanied by increased intracranial pressure, incl. with traumatic brain injury and hemorrhagic stroke;
- Acute vascular insufficiency (with vascular collapse or shock);
- Hypersensitivity to isosorbide, nitrate compounds or any auxiliary component.
If, in case of cardiogenic shock, it is impossible to correct the end diastolic pressure of the left ventricle with drugs with a positive inotropic effect or with the help of intra-aortic balloon counterpulsation, Isoket cannot be used either.
The drug should be used with caution and at the same time not to allow systolic blood pressure to drop below 90 mm Hg. with a tendency to orthostatic reactions, mitral and / or aortic stenosis, as well as diseases accompanied by increased intracranial pressure.
Special observation during treatment is necessary for patients with acute myocardial infarction, if it is accompanied by a reduced filling pressure of the left ventricle.
Dosing and Administration
The solution prepared from a concentrate is intended for intravenous administration by means of automatic infusion systems. The treatment is carried out under careful observation of indicators of the cardiovascular system.
To obtain a 0.01% solution (100 μg / ml), the contents of 5 ampoules are diluted to 500 ml. To prepare a 0.02% solution (200 μg / ml) to a volume of 500 ml, dilute the contents of 10 ampoules.
For dilution using a physiological solution, 5-30% glucose solutions, Ringer's solution or containing albumin solutions.
The dose is selected individually. It is recommended to start treatment with the minimum dosage (1-2 mg / hour) and gradually increase it to an effective one (as a rule, it is 2-7 mg / hour). In severe cases, the dose is increased to 10 mg / hour, with heart failure, to 50 mg / h.
The duration of treatment depends on the clinical picture of the disease, ECG indicators and hemodynamics.
In the form of a dosed spray for the prevention and relief of angina Isoket prescribed by 1-3 doses (1 dose corresponds to 1 injection).
In acute myocardial infarction or heart failure after it, the drug is prescribed in the same dose. During the application of Isoketa, blood pressure and heart rate are monitored. In the absence of the desired effect for 5 minutes, repeat the injection. If no improvement occurs within the next 10 minutes, a third application is allowed.
The aerosol cannot be inhaled. It is used as follows: bring the dosing device close to the mouth, then take a deep breath, hold the breath and, pressing the dispenser, inject the aerosol into the oral cavity, after which the mouth is closed and for about 30 seconds they breathe through the nose. During the injection the bottle must be held vertically with the sprayer facing up.
When using the aerosol for the first time and if more than a day has passed since the last application, the first spraying should be done in the air, by fully pressing the sprayer and releasing it again.
Treatment is not stopped abruptly, the drug is canceled gradually.
With the first use of Isoketa and with increasing dosage, blood pressure may decrease and orthostatic hypotension develops, which is accompanied by inhibition, feeling of weakness, dizziness and an increase in heart rate.
With a pronounced decrease in blood pressure, angina pectoris may increase and the development of collapse.
In some cases, at the beginning of treatment, patients complain of headaches, but they usually disappear in subsequent applications.
There are isolated cases of collaptoid states, sometimes with bradycardia, impaired consciousness and dizziness due to cerebral circulation disorder due to heart rhythm disturbances.
In addition, such side effects are possible with the use of Isoketa:
- Dry mouth, nausea and / or vomiting;
- Blurred vision, drowsiness, stiffness, reduced speed of motor and mental reactions;
- Sensation of heat, redness of the skin of the face, exfoliative dermatitis, skin allergic reactions.
In some cases, developing tolerance, including cross-to other nitrates.
During spray injection, a slight burning sensation of the tongue is possible.
The possible symptoms of an overdose of isosorbide dinitrate are: headache, fainting, dizziness, collapse, palpitations, hyperthermia, visual disturbances, convulsions, nausea, increased sweating, vomiting, skin hyperemia, diarrhea, bradycardia, heart failure, diarrhea, bradycardia, metastogloblemia, nausea, hyperemia of the skin, diarrhea, bradycardia, metastogloblemia, nausea, hyperemia of the skin, diarrhea, bradycardia, methemoglolomamia, nausea, hyperaemia Treatment is symptomatic, with severe hypotension, administration of phenylephrine (mezaton) and epinephrine (adrenaline) is indicated, with methemoglobinemia - 1% of methylene blue.
During the period of treatment, regular monitoring of the cardiovascular system parameters is necessary: heart rate, blood pressure, ECG monitoring, urinary volume.
Too frequent use of Isoketa and / or in high doses may cause the development of tolerance. To prevent this, it is recommended after 3-6 weeks of therapy to take 3-5-day breaks, applying at this time another antianginal agent.
Alcohol should not be consumed during treatment.
When using Isoketa in the form of a spray, it is necessary to periodically check the operation of the sprayer. Below on the label pasted on the bottle, there is an arrow, as soon as the liquid level reaches its upper edge, it's time to buy the next bottle.
The drug can reduce a person's rapid motor and mental reactions, especially at the beginning of treatment and with increasing doses. This should be taken into account by people driving a car and engaged in potentially hazardous industries.
Strengthening the hypotensive effect is observed with the simultaneous use of Isoketa and vasodilators (vasodilators), beta-adrenoblockers, antihypertensive drugs, neuroleptics, slow calcium channel blockers, tricyclic antidepressants, dihydroergotamine, ethanol, phosphoesthesterapters, and anesthesia, as an inhibitor.
Strengthening antianginal action is possible with a combination of Isoketa with verapamil, nifedipine, propranolol, amiodarone. A decrease in the antianginal effect is noted with the simultaneous use of alpha-blockers and sympathomimetics.
It is not recommended to use Isocet in patients who are prescribed m-anticholinergics, as the risk of increased intracranial pressure increases.
Dinisorb, Dinitrosorbilong, Izacardine, Isacardine, Cardeket, Nisoperkuten, Nitrosorbide.
Terms and conditions of storage
Store the drug should be in a dark place at temperatures up to 25 ºC. Isoketa shelf life is 5 years. The solution prepared from a concentrate is suitable for use within 24 hours.