Isoket IV Caution For Usage

Incompatibilities: Polyvinyl chloride (PVC) or polyurethane (PU) giving sets and containers should not be used since significant losses of the active ingredient by adsorption occur and it has not been verified how the dose can be adjusted to suit the patient's needs to account for this adsorption.
This medicinal product must not be mixed with other medicinal products except those mentioned in Use and Handling as follows.
Use and Handling: Isosorbide dinitrate 1 mg/ml solution for infusion or injection is oversaturated with the active substance, therefore, crystallisation may occur in undiluted form. If crystals are observed, it is safer not to use the solution, although under normal conditions, efficacy is not impaired.
Isosorbide dinitrate must be diluted under aseptic conditions immediately after opening. The diluted solution is to be used immediately. Any unused contents of the container should be discarded.
This medicinal product contains isosorbide dinitrate in isotonic solution and is compatible with commonly employed infusion fluids, such as sodium chloride solution, dextrose solution, 5-30% glucose solution, Ringer's solution and solutions containing albumin. No incompatibilities have so far been demonstrated.
This product is compatible with glass infusion bottles and infusion packs made from polyethylene (PE), polypropylene (PP) or polytetrafluoroethylene (PTFE). Isosorbide dinitrate may be infused slowly using a syringe pump with glass or plastic syringe.
Example of admixture preparation: To obtain a dose of 6 mg per hour, add 50 ml of isosorbide dinitrate solution for infusion or injection 1 mg/ml to 450 ml of a suitable vehicle, under aseptic conditions. The resultant admixture (500 ml) contains 100 μg/ml (1 mg/10 ml) isosorbide dinitrate. An infusion rate of 60 ml per hour (equivalent to 60 paediatric microdrops per minute or 20 standard drops per minute) will deliver the required dose of 6 mg per hour.
Should it be necessary to reduce fluid intake, 100 ml of isosorbide dinitrate solution for infusion or injection 1 mg/ml may be diluted to 500 ml using a suitable vehicle. The resultant solution now contains 200 μg/ml (2 mg/10 ml) isosorbide dinitrate. An infusion rate of 30 ml per hour (equivalent to 30 paediatric microdrops per minute or 10 standard drops per minute), will deliver the required dose of 6 mg per hour.
A dilution of 50% is advocated to produce a solution containing 0.5 mg/ml where fluid intake is strictly limited.