Sign Out
Signs and symptoms: Symptoms could include the following: Fall in blood pressure ≤90 mmHg, Pallor, Sweating, Weak pulse, Reflex tachycardia, Collapse, Syncope, Dizziness postural, Headache, Asthenia, Dizziness, Nausea, Vomiting, Diarrhea.
Methemoglobinemia has been reported in patients receiving other organic nitrates. During glyceryl trinitrate 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 glyceryl trinitrate 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 should be kept horizontal with the head lowered and legs raised or, if necessary, compression bandaging of the patient's legs.
Supply oxygen.
Expand plasma volume.
For specific shock treatment admit patient to intensive care unit.
Special procedure: Raising the blood pressure if the blood pressure is very low.
Treatment of methemoglobinemia: Treatment with intravenous methylene blue: Initially 1 to 2 mg/kg, not exceeding 4 mg/kg of a 1% solution over 5 minutes.
Repeat dose in 60 minutes if there is no response.
Administer oxygen (if necessary).
Initiate artificial ventilation.
Treatment of methemoglobinemia with methylene blue is contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency or methemoglobin reductase deficiency.
Where treatment with methylene blue is contraindicated or is not effective, exchange transfusion and/or transfusion of packed red blood cells is recommended.
Resuscitation measures: In case of signs of respiratory and circulatory arrest, initiate resuscitation measures immediately.
