Forensic epidemiologic analysis of the cause of an unexpected teen suicide following ingestion of mis-dispensed isosorbide mononitrate

A 17 year-old previously healthy male committed suicide approximately 1 day after ingesting isosorbide mononitrate, an organic nitrate drug used to treat symptoms of coronary artery disease. The drug had been mis-dispensed by a pharmacy in place of a prescribed anti-inflammatory. In the presented case study, a 3-step probabilistic causal analysis was used to evaluate the most likely cause of the suicide, suitable for presentation in a legal setting as evidence of causation on a more probable than not (> 50 % probable) basis.