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Nitroglycerin and the isosorbides are converted to nitric oxide through the action of mitochondrial aldehyde dehydrogenase (encoded by the ALDH2 gene)

Seek urgent medical attention (call 999 or attend A&E) if you experience: Severe abdominal pain, particularly if accompanied by vomiting Signs of pancreatitis: severe upper abdominal pain radiating to the back Symptoms of severe dehydration: confusion, rapid heartbeat, very low urine output Allergic reactions: difficulty breathing, facial swelling, severe rash Your healthcare provider may wish to investigate potential underlying causes of fatigue through blood tests , including: Full blood count (to check for anaemia) Thyroid function tests Vitamin B12 and folate levels Iron studies Kidney and liver function HbA1c (if diabetic or pre-diabetic) In some cases, dose adjustment or temporary treatment interruption may be necessary to allow recovery from side effects