Isosorbide dinitrate toxicity

The direct injection of potent vasodilatory agents such as papaverine or isosor-bide dinitrate, into the ventricles of the heart reverses the action of palytoxin in approximately one-half of the animals. These extreme measures are required because palytoxin kills quickly. Antidotes injected into the venous circulation were not able to reach the heart because the stagnation of venous blood occurs so rapidly that antidotes are simply pooled on the venous side of the circulation and never reach the heart. In these studies isosorbide dinitrate appeared to be approximately twice as effective as papaverine in reversing the toxic effects of palytoxin. 

Sun P, Borowitz JL, Kanthasamy AG, etal. 1995. Antagonism of cyanide toxicity by isosorbide dinitrate possible role of nitric oxide. Toxicology 104 105-111. 

The hexitol anhydrides also have medicinal uses.97 Carr and Krantz98 found that l,4 3,6-dianhydro-D-mannitol was quite non-toxic to man and was a valuable diuretic. The dinitrates of both isomannide and isosorbide" have possible uses as agents for lowering blood pressure, though Burn and Stephenson100 found that the D-sorbitol derivative was twice as active as the D-mannitol derivative in this respect. 2,5-Diam-ino-2,5-didesoxy-l,4 3,6-dianhydro-D-mannitol and -D-sorbitol have been prepared and their sulfanilamido derivatives obtained.101 These however showed no outstanding bacteriostatic activity. 

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