Sildenafil
Contraindicated
Database
Severe hypotension.
Absolute contraindication.
Source: DDInter
Drug reference
isosorbide
Osmotic Diuretic · Diuretic
Osmotic DiureticDiuretic
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
7 major
incl. contraindicated
PREGNANCY
—
not curated
Top interactionssee all 7 →
- SildenafilContraindicatedDatabaseDDInter
- TadalafilContraindicatedDatabaseDDInter
- AvanafilSevereDatabaseDDInter
- Nitrous AcidSevereDatabaseDDInter
Mechanism
Isosorbide acts as a nonreabsorbable solute in the proximal tubule and loop of Henle. It limits the osmosis of water into the interstitial space, reducing luminal Na+ concentration and ceasing net Na+ reabsorption. By extracting water from intracellular compartments, it expands extracellular fluid volume and reduces medullary tonicity, which diminishes passive NaCl reabsorption in the ATL.
Indications
dialysis disequilibrium syndromecontrol intraocular pressure (acute attacks, preoperatively, postoperatively in ocular surgery)reduce cerebral edemareduce brain mass (before and after neurosurgery, in traumatic brain injury)Reduce intraocular or intracranial tension
Dosing
- Adult
- 0.5–1.5 g/kg as oral solution
Pharmacokinetics
Half-life
5–9.5
Bioavailability
Orally active
Excretion
renal excretion of intact drug
Contraindications
- anuric due to severe renal disease
- active cranial bleeding
- heart failure
- pulmonary congestion
Side effects
Common
headachenauseavomiting
Serious
- pulmonary edema (in heart failure or pulmonary congestion)
- hyponatremia
- hypernatremia
- dehydration
Drug interactions
Tadalafil
Contraindicated
Database
Dangerous hypotension
Absolute contraindication.
Source: DDInter
Avanafil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Nitrous Acid
Severe
Database
Clinical effect not specified
Source: DDInter
Riociguat
Severe
Database
Clinical effect not specified
Source: DDInter
Tizanidine
Severe
Database
.
Source: DDInter
Vardenafil
Severe
Database
Clinical effect not specified
Source: DDInter
5 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.
Related guidelines
Other Osmotic Diuretic drugs
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Sources: KD Tripathi 7e, Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team