Sign Out
Symptoms: The following symptoms were observed: fall of blood pressure ≤90 mmHg, pallor, sweating, weak pulse, tachycardia, postural dizziness, headache, asthenia, dizziness, nausea, vomiting, diarrhea.
Methemoglobinemia has been reported in patients receiving other organic nitrates. During Isosorbide Dinitrate (Isoket) biotransformation, nitrite ions are released, which may induce methemoglobinemia and cyanosis with subsequent tachypnea, anxiety, loss of consciousness and cardiac arrest. It cannot be excluded that an overdose of Isoket may cause this adverse reaction.
In very high doses, the intracranial pressure may be increased. This might lead to cerebral symptoms.
Treatment: General Procedure: Stop delivery of the drug.
General Procedures in the Event of Nitrate-Related Hypotension: The patient must be laid down with lowered head and raised legs; supply oxygen; expand plasma volume (I.V. fluids), specific shock treatment (admit patient to intensive care unit).
Special Procedure: Raise the blood pressure if the blood pressure is very low; vasopressors should be used only in patients who do not respond to adequate fluid resuscitation.
Treatment of Methemoglobinemia: Reduction therapy of choice with vitamin C, methylene-blue, or toluidine-blue; administer oxygen (if necessary); initiate artificial ventilation.
Resuscitation Measures: In case of signs of respiratory and circulatory arrest, initiate resuscitation measures immediately.
Further management should be as clinically indicated or as recommended by the national poisons centre, where available.
