Sorbitrate-induced atrial fibrillation with hypotension: A pharmacovigilance case report

Abstract:

Adverse drug reactions (ADRs) are a significant cause of morbidity and healthcare burden. Isosorbide dinitrate (sorbitrate), a commonly used nitrate for angina, is generally well tolerated but may rarely cause cardiovascular adverse effects. We report a case of a 45-year-old male with chronic kidney disease on maintenance hemodialysis who developed atrial fibrillation with a fast ventricular rate and hypotension shortly after administration of sublingual sorbitrate for acute chest pain. The patient required pharmacological rate control and supportive management, following which he showed clinical improvement. Causality assessment using the Naranjo ADR probability scale and World Health Organization-Uppsala Monitoring Centre criteria indicated a probable association. The reaction was classified as severe and definitely preventable based on standard assessment tools. This case highlights a rare but clinically significant adverse effect of nitrates and underscores the importance of careful monitoring and pharmacovigilance reporting.