Diuretics isosorbide

Manufacture of vitamin C starts with the conversion of sorbitol to L-sorbose. Sorbitol and xyHtol have been used for parenteral nutrition following severe injury, bums, or surgery (246). An iron—sorbitol—citric acid complex is an intramuscular bematinic (247). Mannitol administered intravenously (248) and isosorbide administered orally (249) are osmotic diuretics. Mannitol hexanitrate and isosorbide dinitrate are antianginal dmgs (see Cardiovascular agents). 

The osmotic diuretics urea and mannitol are administered intravenously (IV), whereas glycerin and isosorbide are administered orally Administration by the IV route may result in a rapid fluid and electrolyte imbalance, especially when these drugs are administered before surgery with the patient in a fasting state ... 

More recently, the value of adding the combination of isosorbide dinitrate 40 mg and hydralazine 75 mg three times daily to therapy including ACE inhibitors, P-blockers, digoxin, and diuretics was evaluated in a prospective, randomized trial26 The study enrolled only African-American patients and demonstrated a significant reduction in mortality, as well as first hospitalization for HF. Quality-of-life scores were also improved over placebo. Combination therapy with hydralazine and isosorbide dinitrate is an appropriate substitute for angiotensin II antagonism... 

The hexitol anhydrides also have medicinal uses.97 Carr and Krantz98 found that l,4 3,6-dianhydro-D-mannitol was quite non-toxic to man and was a valuable diuretic. The dinitrates of both isomannide and isosorbide" have possible uses as agents for lowering blood pressure, though Burn and Stephenson100 found that the D-sorbitol derivative was twice as active as the D-mannitol derivative in this respect. 2,5-Diam-ino-2,5-didesoxy-l,4 3,6-dianhydro-D-mannitol and -D-sorbitol have been prepared and their sulfanilamido derivatives obtained.101 These however showed no outstanding bacteriostatic activity. 

Hydralazine and dihydralazine are predominantly arterial vasodilators which cause a reduction in peripheral vascular resistance but also reflex tachycardia and fluid retention. They were used in the treatment of hypertension, in combination with a -blocker and a diuretic. Long-term use of these compounds may cause a condition resembling lupus erythematodes with arthrosis, dermatitis and LE-cells in the blood. This risk is enhanced in women and in patients with a slow acetylator pattern. When combined with the venous vasodilator isosorbide (an organic nitrate) hydralazine was shown to be mildly beneficial in patients with congestive heart failure (V-HEFT I Study). Hydralazine and dihydralazine have been replaced by other therapeutics, both in hypertension treatment and in the management of heart failure. 

Isosorbide is an orally active diuretic, most commonly used in the emergency treatment of acute angle-closure glaucoma. 

As their name suggests, osmotic diuretics such as mannitol (Osmitrol), isosorbide (Ismotic), and glycerin (Osmoglyn) draw fluid from the tissues of the body through principles of osmosis. Osmotic diuretics are typically given to treat or prevent acute renal failure (kidney failure). They may also be used to relieve intracranial pressure (swelling of the brain) in cases of head injury or hydrocephalus. 

Insom-X see GBL GHB Invigorate see GBL GHB Ionamin see Diet pills Iophen DM NR see Dextromethorphan Ischott see Catha edulis Isobutyl nitrite see Inhalants Isocarboxazid Marplan see Antidepressants Isosorbide see Diuretics Iubulu see Catha edulis J La rocha see Rohypnol La salade see Catha edulis LA turnarounds see Dextroamphetamine Lady see Heroin Lady K see Ketamine Laevoamphetamine see Amphetamines Laudanum see Opium Laughing gas see Nitrous oxide LBJ see PCP (phencyclidine) Leaky bolla see PCP (phencyclidine) Leaky leak see PCP (phencyclidine) Lean (codeine cough syrup) see Codeine... 

Isosorbide is a diuretic the dinitrate is a vasodilator. Hexahydrofuro[3,2-6 ]pyrrole derivatives are useful as bronchodilators and thrombocyte aggregation inhibitors. 3-Amino-4//-pyrrolo[3,4-c]isoxazoles produce hypotension. 3,4,5,6-Tetrahydro-2H-cycIopen-tathiazol-2-one is an effective analgesic. 

Compared with placebo, the combination of hydralazine and isosorbide dinitrate (ISDN) reduced mortality in patients receiving diuretics and digoxin (but not ACE inhibitors or /3-blockers). However, another trial comparing the combination with an ACE inhibitor found that mortality was lower in the ACE inhibitor group. Adverse effects (primarily headache and gastrointestinal complaints) with combined hydralazine-ISDN were common, limiting their use in many patients. Patient compliance also was an important issue because hydralazine-ISDN therapy was given four times daily in these trials. Whether less frequent administration provides equivalent benefit is unknown. 

Like dinretics, therapy should be initiated at low doses in order to avoid hypotension. Isosorbide dinitrate 10 mg three or fonr times daily, isosorbide mononitrate (Imdur) 30 mg/day, nitroglycerin paste 1 /2 to 1 inch every 4 to 6 honrs, and nitroglycerin patch 0.1 to 0.2 mg/h applied each day are common initial doses. Doses can be increased during long-term therapy and titrated against symptoms. Nitrate tolerance has not been studied in this patient population but probably occurs. Similar to diuretics, nitrates can cause hypotension and a low-output syndrome. Headaches are common but may be less frequent with continued use. 

Isosorbide, an osmotic diuretic (1 to 5 mg/kg p.o.), is used for short-term reduction of intraocular pressure from glaucoma. 

ABSORPTION AND ELIMINATION The oral bioavailability, plasma tj, and route of elimination of the available osmotic diuretics are listed in Table 28-3. Glycerin and isosorbide can be given orally mannitol and urea must be administered intravenously. 

Osmotic diuretics are used cautiously in patients with renal or kidney imi>airment or electrolyte imbalance. The osmotic diuretics are Rregnancy Cat iy B (isosorbide) and C (glycerin, mannitol, and urea) dru and must be used cautiously during pr iancy and lactation. Additive hypotensive effects occur when the osmotic diuretics are given witli otlier antihyiiertensive drugs or nitrate. 

Prototypes and Mechanism of Action Mannitol, the prototypical osmotic diuretic, is given intravenously. Other drugs often classified with mannitol (but rarely used) include glycerin, isosorbide, and urea. Because it is freely filtered at the glomerulus but poorly reabsorbed from the tubule, mannitol remains in the lumen and holds water by virtue of its osmotic effect. The major location for this action is the proximal convoluted mbule, where the bulk of isosmotic reabsorption normally takes place. Reabsorption of water is also reduced in the descending limb of the loop of Henle and the collecting tubule. 

Polyols, such as mannitol, sorbitol, and isosorbide, provide this effect. Sugars, such as glucose and sucrose, also can have a diuretic effect by this mechanism. Although not a polyol, urea has a similar osmotic effect and has been used in the past as an osmotic diuretic. 

Isosorbide is basically a bicyclic form of sorbitol that is used orally to cause a reduction in intraocular pressure in glaucoma cases. Although a diuretic effect is noted, its ophthalmologic properties are its primary value. 

Isosorbide is used for medical applications, such as a diuretic agent and can be also used for the treatment of eye diseases to decrease the fluid pressure in the eye. 

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