Skip to Content

Nitropress

Generic Name: Sodium Nitroprusside
Class: Direct Vasodilators
VA Class: CV490
CAS Number: 13755-38-9

Medically reviewed on Jun 4, 2018

Warning

    Dilution
  • Injection concentrate must be diluted further with 5% dextrose injection before infusion.600

    Hypotension
  • Can produce precipitous decreases in BP; profound hypotension can lead to irreversible ischemic injury or death.600

  • Administer in a setting with equipment and personnel available to continuously monitor BP.600

    Cyanide Intoxication
  • Administration (except when used for short periods of time or at low infusion rates [e.g., <2 mcg/kg per minute]) can result in the production of clinically important levels of cyanide ion, which can reach toxic or potentially lethal concentrations.600

  • Infusions at the maximum recommended rate of 10 mcg/kg per minute should never last longer than 10 minutes; if BP is not adequately controlled after 10 minutes, immediately discontinue the infusion.600

  • Acid-base balance and venous oxygen concentrations should be monitored and may indicate cyanide toxicity; these tests alone should not be relied upon to guide therapy.600

Introduction

Vasodilating and hypotensive agent.600

Uses for Nitropress

Hypertensive Crises

For immediate reduction of BP in hypertensive emergencies.500 502 542 550 600 Administer with other longer-acting hypotensive agents to minimize the duration of nitroprusside therapy.600 Use in carefully selected patients because of potential for serious toxicity (see Cautions).542

Hypertensive emergencies may be associated with hypertensive encephalopathy, MI, unstable angina pectoris, acute left ventricular failure with pulmonary edema, acute renal failure, eclampsia, or aortic dissection.500 550

Other antihypertensive agents (e.g., IV hydralazine, IV labetalol, oral nifedipine) preferred for management of acute severe hypertension in preeclampsia; reserve sodium nitroprusside for treatment failures.208 209 500 540

Do not use in patients with compensatory hypertension (e.g., arteriovenous shunt or coarctation of the aorta).600 (See Contraindications under Cautions.)

Congestive Heart Failure

Management of acute decompensated (e.g, congestive) heart failure.524 600

May be considered an adjunct to diuretic therapy for relief of dyspnea in patients hospitalized for acutely decompensated heart failure who do not have symptomatic hypotension.524

Particularly useful in severe heart failure caused by regurgitant valvular lesions of aortic insufficiency and mitral regurgitation; also may be useful in management of heart failure in patients with severe pulmonary congestion and hypertension.26 524

Do not use in patients with acute congestive heart failure associated with reduced peripheral vascular resistance.600 (See Contraindications under Cautions.)

Controlled Hypotension during Surgery

Used to produce controlled hypotension to reduce bleeding during surgery.600 a Do not use in patients with inadequate cerebral circulation or in patients requiring emergency surgery who are near death.600 (See Contraindications under Cautions.)

Acute MI

Vasodilators such as sodium nitroprusside also have been used to improve cardiac output in patients with left ventricular failure and low cardiac output after acute MI.100 101 102 202 527

An inotropic agent (e.g., dobutamine) is used initially to improve myocardial contractility and cardiac output; if BP permits, afterload-reducing agents may be added to decrease cardiac work and pulmonary congestion.202

Nitroglycerin is the preferred vasodilator in patients with acute MI because of its ability to reduce ischemia by reducing left ventricular preload and increasing coronary blood flow.202 527

Nitropress Dosage and Administration

Administration

Administer by IV infusion only.600

Administer in a setting with equipment and personnel available to continuously monitor BP.600

Because of potential for toxicity, administer for the shortest possible duration.550 600

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by IV infusion using a controlled-infusion device (i.e., infusion pump) to allow precise measurement of flow rate.600

Dilution

Injection concentrate (25 mg/mL) must be further diluted prior to IV infusion.600 Dilute contents of one vial (50 mg) in 250–1000 mL of 5% dextrose injection.600 Vials are for single use only.600

Protect from light by promptly wrapping the container in aluminum foil or other opaque material; it is not necessary to cover the infusion drip chamber or tubing.600

Rate of Administration

Adjust rate to maintain the desired hypotensive effect, determined by continuous monitoring of BP, using a continually reinflated sphygmomanometer or, preferably, an intra-arterial pressure sensor.600

When sodium nitroprusside is used in heart failure, titrate rate based on results of invasive hemodynamic monitoring and urine output.600

Dosage

Pediatric Patients

Hypertensive Crises, Controlled Hypotension during Surgery
IV

Initially, 0.3 mcg/kg per minute; gradually titrate upward every few minutes until adequate BP control is achieved or maximum recommended infusion rate of 10 mcg/kg per minute is reached.600 Usual dosage is 3 mcg/kg (range of 0.1–10 mcg/kg) per minute.205 600

Discontinue immediately if adequate reduction in BP is not achieved within 10 minutes in patients receiving the maximum recommended infusion rate of 10 mcg/kg per minute.600

Prolonged infusions should not exceed 3 mcg/kg per minute to prevent thiocyanate (byproduct of sodium nitroprusside metabolism) concentrations from reaching neurotoxic levels; monitor thiocyanate concentrations daily if this rate is exceeded.600

Adults

Hypertensive Crises, Controlled Hypotension during Surgery
IV

Initially, 0.3 mcg/kg per minute; gradually titrate upward every few minutes until adequate BP control is achieved or maximum recommended infusion rate of 10 mcg/kg per minute is reached.600 Usual dosage is 3 mcg/kg (range of 0.1–10 mcg/kg) per minute.600

Management of hypertensive emergency: Experts recommend that BP be reduced by no more than 25% over the first hour, followed by further reduction if stable toward 160/100 to 110 mm Hg within the next 2–6 hours; avoid excessive declines in pressure.550 If this BP is well tolerated and the patient is clinically stable, further gradual reductions toward normal can be implemented in the next 24–48 hours.550 In patients with aortic dissection, severe preeclampsia or eclampsia, or pheochromocytoma crisis, goal is to reduce systolic pressure to <140 mm Hg within first hour of treatment if tolerated.550

Discontinue immediately if adequate reduction in BP is not achieved within 10 minutes in patients receiving the maximum recommended infusion rate of 10 mcg/kg per minute.600

Prolonged infusions should not exceed 3 mcg/kg per minute to prevent thiocyanate (byproduct of sodium nitroprusside metabolism) concentrations from reaching neurotoxic levels; monitor thiocyanate concentrations daily if this rate is exceeded.600

Congestive Heart Failure
IV

Initially, 0.3 mcg/kg per minute; titrate every few minutes and until desired effect is achieved or maximum recommended infusion rate of 10 mcg/kg per minute is reached.600 Usual dosage is 3 mcg/kg (range of 0.1–10 mcg/kg) per minute.600

Adjust infusion rate based on results of invasive hemodynamic monitoring and urine output.600 Increase infusion rate until cardiac output is no longer increasing, systemic BP cannot be further reduced without compromising vital organ perfusion, or maximum recommended infusion rate is reached, whichever occurs first.600

While specific hemodynamic goals must be tailored to the clinical situation, improvements in cardiac output and left ventricular filling pressure must not be achieved at the expense of undue hypotension and consequent hypoperfusion.600

Prolonged infusions should not exceed 3 mcg/kg per minute to prevent thiocyanate (byproduct of sodium nitroprusside metabolism) concentrations from reaching neurotoxic levels; monitor thiocyanate concentrations daily if this rate is exceeded.600

Prescribing Limits

Pediatric Patients

Hypertensive Crises, Controlled Hypotension during Surgery
IV

Maximum 10 mcg/kg per minute.205 600

Adults

Hypertensive Crises, Congestive Heart Failure, Controlled Hypotension during Surgery
IV

Maximum 10 mcg/kg per minute.600

Special Populations

Renal Impairment

Clearance of thiocyanate may be decreased in patients with renal failure.600 Prolonged infusions should not exceed 1 mcg/kg per minute to prevent accumulation of thiocyanate to neurotoxic levels.600

Cautions for Nitropress

Contraindications

  • Treatment of compensatory hypertension (e.g., arteriovenous shunt or coarctation of the aorta).600

  • Controlled hypotension during surgery in patients with inadequate cerebral circulation.600

  • Use during emergency surgery in patients near death.600

  • Congenital (Leber’s) optic atrophy or tobacco amblyopia (associated with absent or deficient thiosulfate sulfurtransferase; patients have unusually high cyanide to thiocyanate ratios).600 (See Cyanide Toxicity under Cautions.)

  • Treatment of acute heart failure associated with reduced peripheral vascular resistance (e.g., high-output heart failure as seen in endotoxic sepsis).600

  • Concomitant use with PDE type 5 inhibitors (e.g., sildenafil) or soluble guanylate cyclase stimulators (e.g., riociguat).600 (See Interactions.)

Warnings/Precautions

Warnings

Excessive Hypotension

Slightly excessive infusion rates can result in profound hypotension; subsequent hemodynamic changes can result in various associated symptoms or BP may decrease to the point where perfusion of vital organs may be compromised.600 (See Boxed Warning.)

This reaction is self-limiting within 1–10 minutes following discontinuance of the infusion; place patient in Trendelenburg’s position during this time to maximize venous return.600

If BP does not normalize within a few minutes, sodium nitroprusside may not be the cause of the hypotension and another cause should be sought.600

Cyanide Toxicity

Infusion at rates >2 mcg/kg per minute generate cyanide ion (CN-) in amounts greater than can be effectively buffered by the methemoglobin normally present in the body.600 (See Boxed Warning.)

The capacity of the buffering system is exhausted by the CN- produced by 500 mcg/kg of sodium nitroprusside; this amount is administered in <1 hour when the drug is administered at 10 mcg/kg per minute.600

The actual frequency of clinically important cyanide toxicity not established.600

Most cases occurred with prolonged use or high dosages; however, elevated cyanide levels, metabolic acidosis, and marked clinical deterioration reported occasionally in patients receiving recommended rates of infusion for only a few hours, and in 1 case, for only 35 minutes.600

Toxic effects of cyanide may be rapid, serious, and fatal; toxicity may manifest as venous hyperoxemia (secondary to the inability of tissues to extract oxygen from erythrocytes, with resultant bright red venous blood), lactic acidosis, air hunger, confusion, and death.600

Monitor acid-base balance and venous oxygen concentrations; these tests may indicate cyanide toxicity.600

Hypertensive patients and those receiving other antihypertensive agents may be more sensitive to the effects of sodium nitroprusside than healthy individuals.600

Sodium thiosulfate has been administered with sodium nitroprusside at infusion rates 5–10 times that of the sodium nitroprusside to accelerate the metabolism of cyanide; coadministration of these agents has not been extensively researched and further study is needed.600

Caution advised; avoid prolonged or excessive dosages of sodium nitroprusside with sodium thiosulfate, since thiocyanate toxicity and/or hypovolemia may result.600 The same precautions and contraindications apply to this method of administration as to the administration of sodium nitroprusside alone.600

General Precautions

Effects on Intracranial Pressure

Sodium nitroprusside can increase intracranial pressure.600

Use with caution in patients with increased intracranial pressure.600

Use during Surgery

Tolerance to loss of blood, anemia, and hypovolemia may be decreased when used for controlled hypotension during surgery.600

If possible, correct preexisting anemia and hypovolemia prior to use.600

Use with extreme caution in patients who are especially poor surgical risks.600

Specific Populations

Pregnancy

No adequate and well-controlled studies in pregnant women; not known whether sodium nitroprusside can cause fetal harm when administered during pregnancy.543 600 Use during pregnancy only when clearly needed.600

Lactation

Not known whether sodium nitroprusside or its metabolites are distributed into milk; discontinue nursing or the drug.600

Pediatric Use

Has been used in pediatric patients <17 years of age, including neonates, for reduction of BP.600 601 In 2 pediatric studies, the drug produced similar effects on mean arterial pressure (MAP) in all age groups, and no novel safety issues were noted.600 601

Hepatic Impairment

Caution in patients with hepatic impairment.600

Renal Impairment

Thiocyanate may accumulate in patients with renal impairment; monitor for thiocyanate toxicity (e.g., neurotoxic effects).600 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

Excessive hypotension, cyanide toxicity.600

Other adverse effects include methemoglobinemia (usually observed only in patients who have received >10 mg/kg of sodium nitroprusside) and thiocyanate toxicity (mildly neurotoxic at serum concentrations of 60 mcg/mL and life-threatening at concentrations of 200 mcg/mL).600

Interactions for Nitropress

Specific Drugs

Drug

Interaction

Comments

Hypotensive agents (e.g., ganglionic blocking agents, negative inotropic agents, inhaled anesthetics)

Potential additive hypotensive effects600 a

PDE type 5 inhibitors (e.g., sildenafil)

Possible additive hypotensive effects600

Concomitant use contraindicated600

Soluble guanylate cyclase stimulators (e.g., riociguat)

Possible additive hypotensive effects600

Concomitant use contraindicated600

Nitropress Pharmacokinetics

Absorption

Onset

Immediate reduction in BP.600

Duration

BP begins to rise immediately when infusion is slowed or stopped; BP returns to pretreatment levels within 1–10 minutes.600

Distribution

Extent

Rapidly distributed.600

Elimination

Metabolism

Sodium nitroprusside is metabolized by combination with hemoglobin to form cyanmethemoglobin and cyanide.600

Essentially all cyanide in the blood is bound to methemoglobin until intraerythrocytic methemoglobin is saturated.600

Cyanide is enzymatically converted to thiocyanate by thiosulfate sulfurtransferase (a mitochondrial enzyme).600 This enzyme normally is present in excess quantities; the rate-limiting step in the conversion to thiocyanate is the availability of sulfur donors (e.g., thiosulfate, cystine, cysteine).600

Cyanide not otherwise removed binds to cytochromes.600

Elimination Route

Eliminated principally in urine as thiocyanate.600 Some cyanide is expired as hydrogen cyanide.600

Half-life

Sodium nitroprusside: Circulation half-life: 2 minutes.600

Thiocyanate: 3 days.600

Special Populations

Half-life of thiocyanate is increased in patients with renal failure.600

Stability

Storage

Parenteral

Injection

20–25°C; protect from light by storing in the carton.600

If properly protected from light, diluted solutions are stable for 24 hours.600

Sodium nitroprusside solution can be inactivated by reactions with trace contaminants; products of these reactions are often blue, green, or red and are much brighter than the very faint brownish tint of freshly prepared unreacted sodium nitroprusside solutions.600 Discard discolored solutions or solutions with visible particulate matter.600

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

The manufacturer states that no other drug should be admixed in the sodium nitroprusside solution.600

Parenteral

Solution CompatibilityHID

Compatible

Ringer’s injection, lactated (when protected from light)

Variable

Dextrose 5% in water (compatible when protected from light)

Sodium chloride 0.9% (compatible when protected from light)

Drug Compatibility
Y-Site CompatibilityHID

Compatible

Alprostadil

Argatroban

Atracurium besylate

Bivalirudin

Calcium chloride

Dexmedetomidine HCl

Diltiazem HCl

Dobutamine HCl with lidocaine HCl

Dobutamine HCl with nitroglycerin

Dopamine HCl

Dopamine HCl with dobutamine HCl

Dopamine HCl with lidocaine HCl

Dopamine HCl with nitroglycerin

Enalaprilat

Epinephrine HCl

Esmolol HCl

Famotidine

Furosemide

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Indomethacin sodium trihydrate

Insulin, regular

Isoproterenol HCl

Labetalol HCl

Lidocaine HCl

Lidocaine HCl with dobutamine HCl

Lidocaine HCl with dopamine HCl

Lidocaine HCl with nitroglycerin

Magnesium sulfate

Metoprolol tartrate

Micafungin sodium

Midazolam HCl

Milrinone lactate

Morphine sulfate

Nesiritide

Nicardipine HCl

Nitroglycerin

Nitroglycerin with dobutamine HCl

Nitroglycerin with dopamine HCl

Nitroglycerin with lidocaine HCl

Norepinephrine bitartrate

Pancuronium bromide

Potassium chloride

Potassium phosphates

Procainamide HCl

Propofol

Tacrolimus

Theophylline

Vecuronium bromide

Incompatible

Levofloxacin

Variable

Amiodarone HCl

Cisatracurium besylate

Dobutamine HCl

Haloperidol lactate

Actions

  • Potent direct arterial and venous dilator.600 602

  • The hypotensive action results from peripheral vasodilation caused by a direct action on vascular smooth muscle.600

  • Direct vasodilation causes decreases in right and left ventricular filling (preload) resulting in relief of pulmonary congestion and reduced left ventricular volume and pressure.600 Arteriolar relaxation causes decreases in peripheral arterial resistance (afterload) resulting in enhanced systolic emptying with reduced left ventricular volume and wall stress and reduced myocardial oxygen consumption.600

  • May exert a direct coronary vasodilator effect.600

  • Induces renal vasodilation generally proportional to decreases in systemic BP with no appreciable changes in renal blood flow or GFR.600

Advice to Patients

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.600

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and herbal supplements, as well as any concomitant illnesses.600

  • Importance of informing patients of other important precautionary information.600 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Sodium Nitroprusside

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, concentrate, for IV infusion only

25 mg/mL*

Nitropress

Hospira

Sodium Nitroprusside Injection

AHFS DI Essentials. © Copyright 2018, Selected Revisions June 4, 2018. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

26. Chatterjee K, Parmley WW, Swan HJ et al. Beneficial effects of vasodilator agents in severe mitral regurgitation due to dysfunction of subvalvar apparatus. Circulation. 1973; 48:684-90. http://www.ncbi.nlm.nih.gov/pubmed/4744778?dopt=AbstractPlus

100. Franciosa JA, Limas CJ, Guiha NH et al. Improved left ventricular function during nitroprusside infusion in acute myocardial infarction. Lancet. 1972; 1:650-4. http://www.ncbi.nlm.nih.gov/pubmed/4125161?dopt=AbstractPlus

101. Chatterjee K, Parmley WW, Ganz W et al. Hemodynamic and metabolic responses to vasodilator therapy in acute myocardial infarction. Circulation. 1973; 48:1183-93. http://www.ncbi.nlm.nih.gov/pubmed/4762476?dopt=AbstractPlus

102. Armstrong PW, Walker DC, Burton JR et al. Vasodilator therapy in acute myocardial infarction. A comparison of sodium nitroprusside and nitroglycerin. Circulation. 1975; 52:1118-22. http://www.ncbi.nlm.nih.gov/pubmed/810265?dopt=AbstractPlus

202. Antman EM, Anbe DT, Armstrong PW et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004; 110:e82-292. http://www.ncbi.nlm.nih.gov/pubmed/15339869?dopt=AbstractPlus

205. National high blood pressure education program working group on hypertension control in children and adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114(Suppl 2):555-76.

208. Duley L, Meher S, Jones L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev. 2013; 7:CD001449. http://www.ncbi.nlm.nih.gov/pubmed/23857334?dopt=AbstractPlus

209. ACOG task force on hypertension in pregnancy: hypertension in pregnancy. Washington, DC: American College of Obstetricians and Gynecologists; 2013.

500. National Heart, Lung, and Blood Institute National High Blood Pressure Education Program. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Bethesda, MD: National Institutes of Health; 2004 Aug. (NIH publication No. 04-5230.)

502. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013; 31:1281-357. http://www.ncbi.nlm.nih.gov/pubmed/23817082?dopt=AbstractPlus

524. WRITING COMMITTEE MEMBERS, Yancy CW, Jessup M et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128:e240-327.

527. O'Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013; 127:e362-425. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=3695607&blobtype=pdf

540. Magee LA, Pels A, Helewa M et al., for the Canadian Hypertensive Disorders of Pregnancy (HDP) Working Group. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertens. 2014; 4:105-45. http://www.ncbi.nlm.nih.gov/pubmed/26104418?dopt=AbstractPlus

542. Marik PE, Varon J. Hypertensive crises: challenges and management. Chest. 2007; 131:1949-62. http://www.ncbi.nlm.nih.gov/pubmed/17565029?dopt=AbstractPlus

543. Nitroprusside. In: Briggs GG, Freeman RK, Yaffe SJ. Drug in pregnancy and lactation: a reference guide to fetal and neonatal risk. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2002:1008.

550. Whelton PK, Carey RM, Aronow WS et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017; http://www.ncbi.nlm.nih.gov/pubmed/29133354?dopt=AbstractPlus

600. Hospira Inc. Nitropress (sodium nitroprusside) injection prescribing information. Lake Forest, IL; 2017 Oct.

601. Food and Drug Administration. Pediatric studies of sodium nitroprusside conducted in accordance with the public health service act; availability of summary report and requested labeling changes. [Docket No. FDA-2012-N-02848]. Fed Regist. 2014; 79:4167-8.

602. Hottinger DG, Beebe DS, Kozhimannil T et al. Sodium nitroprusside in 2014: A clinical concepts review. J Anaesthesiol Clin Pharmacol. 2014; 30:462-71. http://www.ncbi.nlm.nih.gov/pubmed/25425768?dopt=AbstractPlus

700. Yancy CW, Jessup M, Bozkurt B et al. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2016; :.

701. Ponikowski P, Voors AA, Anker SD et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; :. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=4946749&blobtype=pdf

703. Ansara AJ, Kolanczyk DM, Koehler JM. Neprilysin inhibition with sacubitril/valsartan in the treatment of heart failure: mortality bang for your buck. J Clin Pharm Ther. 2016; 41:119-27. http://www.ncbi.nlm.nih.gov/pubmed/26992459?dopt=AbstractPlus

a. AHFS Drug Information. McEvoy GK, ed. Sodium nitroprusside. Bethesda, MD: American Society of Health-System Pharmacists.

HID. Trissel LA. Handbook on injectable drugs. 18th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2015:1065–72.

Hide