Drug General Information (ID: DDITD9O84V)
Drug Name			Isosorbide dinitrate		Drug Info		Nitrous acid		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Vasodilator Agents				Antidotes
Structure

Mechanism of Isosorbide dinitrate-Nitrous acid Interaction (Severity Level: Major)
Increased risk of methemoglobinemia Click to Show/Hide Mechanism Graph
Drug Name		Isosorbide dinitrate				Nitrous acid
Mechanism		Methemoglobinemia				Methemoglobinemia
Key Mechanism Factor 1
		Factor Name		Methemoglobinemia
		Factor Description		Methemoglobinemia is a condition in which higher than normal levels of methemoglobin are found in the blood. Methemoglobinemia is a potentially life-threatening condition in which the oxygen-carrying capacity of circulating hemoglobin is reduced due to the conversion of some or all of the four iron species from the reduced ferrous (Fe2+) state to the oxidized iron (Fe3+) state.
Mechanism Description		Increased risk of methemoglobinemia by the combination of Isosorbide dinitrate and Nitrous acid

Recommended Action
Management		Sodium nitrite should be used with caution in the presence of other methemoglobin-inducing drugs. Patients should be closely monitored to ensure adequate perfusion and oxygenation during treatment with sodium nitrite. Methemoglobin levels should be monitored and oxygen administered whenever possible.

References
1	Coleman MD, Coleman NA "Drug-induced methaemoglobinaemia: treatment issues." Drug Saf 14 (1996): 394-405. [PMID: 8828017]
2	Product Information. Sodium Nitrite (sodium nitrite). Hope Pharmaceuticals, Scottsdale, AZ.
3	Rehman HU "Methemoglobinemia." West J Med 175 (2001): 193-6. [PMID: 11527852]