Pronunciation: nye-troe-PRUSS-ide SO-dee-uhm
Class: Agent for hypertensive emergencies
- Powder for injection 50 mg/vial
Relaxes vascular smooth muscle and dilates peripheral veins and arteries.
Indications and Usage
Immediate reduction of BP in hypertensive crisis; production of controlled hypotension to reduce bleeding during surgery; for acute congestive heart failure.
Has been used alone or with dopamine in acute MI.
Treatment of compensatory hypertension, in which primary hemodynamic lesion is aortic coarctation or arteriovenous shunting; to produce hypotension during surgery in patients with known inadequate cerebral circulation or in moribund patients (A.S.A. Class 5E) coming to emergency surgery; patients with congenital (Leber's) optic atrophy or with tobacco amblyopia; acute CHF associated with reduced peripheral vascular resistance.
Dosage and Administration
Give by IV infusion using infusion pump, preferably volmetric pump.Adults and Children
IV 0.3 mcg/kg/min initially; titrate upward gradually every few minutes to desired effect. Do not exceed 10 mcg/kg/min. Do not use maximum rate for more than 10 min. Average rate of infusion is 3 mcg/kg/min; some patients require much lower doses, especially if other hypotensive agents are used.
- Dilute 50 mg in 2 mL D5W. Add to 250 to 500 mL D5W. Resulting solution is 200 mcg/mL or 100 mcg/mL. Use only D5W. No other medication should be infused with nitroprusside. Protect solution from light. However, it is not necessary to protect drip chamber or tubing.
- Do not use if solution is discolored or if particulate matter is seen.
Store diluted solution at room temperature (59° to 86°F) for no longer than 24 h and protect from light.
Drug InteractionsAntihypertensives, ganglionic blocking agents, volatile anesthetics (eg, enflurane, halothane)
Additive hypotensive effects.
Laboratory Test Interactions
None well documented.
Evidence of rapid BP reduction (eg, abdominal pain; apprehension; diaphoresis; dizziness; headache; muscle twitching; nausea; palpitations; restlessness; retching; retrosternal discomfort); bradycardia; ECG changes; tachycardia.
Flushing; venous streaking; irritation at infusion site; rash.
Methemoglobinemia; decreased platelet aggregation.
Thiocyanate toxicity; cyanide toxicity; increased intracranial pressure.
Administration is not suitable for direct injection and requires dilution prior to infusion.Cyanide toxicity
Accumulation of cyanide ion may occur.Hypotension
Hypotension can cause significant drops in BP leading to irreversible ischemic injury or death. Requires appropriate monitoring equipment and experienced personnel.
Category C .
May be more sensitive to hypotensive effects.
Cyanide may accumulate in patients with hepatic function impairment.
Patient's ability to compensate for anemia and hypovolemia may be diminished during anesthesia.
Infusions faster than 2 mcg/kg/min generate cyanide faster than body can dispose of it. Symptoms of cyanide toxicity include venous hyperoxemia with bright red venous blood, metabolic (lactic) acidosis, air hunger, confusion and death.
Use with extreme caution in patients with elevated intracranial pressure; nitroprusside can increase intracranial pressure.
Clinically significant methemoglobinemia is seen rarely, but suspect condition in patients who have received more than 10 mg/kg of nitroprusside and who have signs of impaired oxygen delivery despite adequate cardiac output and arterial Po 2 . Blood may be chocolate brown.
Severe renal disease, anuria
Thiocyanate may accumulate.
Cyanide is eliminated in form of thiocyanate. When cyanide elimination is accelerated by infusion of thiosulfate or when prolonged infusions are used, thiocyanate levels may increase. Thiocyanate is neurotoxic (tinnitus, miosis, hyperreflexia) and toxicity may be life threatening.
Severe hypotension, dyspnea, loss of consciousness, metabolic acidosis, headache, death.
- Instruct patient to report the following symptoms to health care provider: dizziness; retching, nausea, abdominal pain, chest pain, palpitations, tinnitus, or flushing.
- Caution patient to avoid sudden position changes to prevent orthostatic hypotension.
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