Fate of orally given isosorbide dinitrate in cirrhotic patients.

In 5 out of 7 patients with cirrhosis and extensive shunting, plasma concentrations of isosorbide dinitrate after oral administration of 10 mg of the substance were markedly higher than those found in subjects without hepatic disease. The explanation could be a higher bioavailability and/or a lower systemic clearance, due to shunting and hepatic cell dysfunction. The difference was confirmed by the calculation of the areas under the concentration-time curves.