Isoket (Isosorbide Dinitrate) Compatibility with D5W
Yes, Isoket drip is compatible with D5W (5% dextrose in water) and can be safely diluted in this solution for intravenous infusion.
Standard Dilution Practice
Isosorbide dinitrate infusions are routinely prepared using D5W as the diluent in clinical practice. 1 The medication maintains chemical stability when diluted in dextrose solutions, similar to other vasodilator medications used in acute cardiac care settings.
Clinical Context for Use
Isosorbide dinitrate (often combined with hydralazine) is used primarily in heart failure management:
For African American patients with NYHA Class III-IV heart failure who remain symptomatic despite optimal therapy with ACE inhibitors and beta-blockers, the combination of hydralazine and isosorbide dinitrate reduces morbidity and mortality 1
For ACE inhibitor-intolerant patients, this vasodilator combination serves as an alternative therapy, though compliance can be challenging due to adverse effects (headache, gastrointestinal complaints) 1
Important Considerations When Using D5W
Avoid D5W in Specific Clinical Scenarios
Do not use D5W-containing solutions in acute stroke patients, as glucose can have detrimental effects in acute brain injury of all types 1. Normal saline should be used instead for stroke patients in the emergency department.
Volume and Glucose Monitoring
D5W provides minimal plasma volume expansion (only 80-100 mL per liter expands plasma volume) since most water shifts intracellularly after dextrose metabolism 2
Monitor blood glucose levels when using D5W as a drug vehicle, particularly in diabetic patients, regardless of infusion rate 3
In patients with cardiac or renal compromise, limit D5W infusion rates to ≤100 mL/hour and monitor closely for fluid overload 2, 4
Practical Administration
The infusion rate for isosorbide dinitrate will be determined by the medication dosing requirements rather than fluid volume needs, as D5W serves as the vehicle for drug delivery 2. Standard maintenance D5W rates of approximately 100 mL/hour are appropriate for most adult patients when used as a medication diluent 4, 3.