Isosorbide

ISMOTIC

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Pronunciation: eye-soe-SOR-bide

Isosorbide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Isosorbide ballicule

Isosorbide ISMOTIC mascot mnemonic cartoon — Visual mnemonic: Isosorbide mascot
**“Osmotic ice sorbet”**
osmotic diuretic, not to be confused with nitrate vasodilators
decreases serum lithium

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.

Isosorbide molecular structure (skeletal formula) — Molecular structure: Isosorbide

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

Available strengths

tab 5, 10, 20, 30 mg

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

Cost

Isosorbide (ISMOTIC)

Strength		#/mo	CostPlus
5 mg	tab	60 BID	not offered
10 mg	tab	60 BID	not offered
20 mg	tab	60 BID	not offered
30 mg	tab	60 BID	not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Isosorbide is dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskOsmotic diarrhea and nausea

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Sedation liability1 / 4

Direct muscarinic antagonism0 / 4

Legacy pregnancy categoryB

Defining liabilityFluid and electrolyte disturbances

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Memory aids: interaction avatars

Box: minimal PK interactions

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