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Nitroprusside Pregnancy and Breastfeeding Warnings

Nitroprusside is also known as: Nitropress

Nitroprusside Pregnancy Warnings

Several case reports of the use of nitroprusside to treat severe preeclampsia in human pregnancy have been reported. In one case, 15 hours after a nitroprusside infusion was begun (3.9 mcg per kg per min) a woman delivered a 478 gram stillborn infant without any obvious abnormalities. Autopsy revealed an infant of normal size for gestational age, no teratogenicity, and nontoxic fetal liver cyanide concentrations. The cause of death was thought to be due to uteroplacental insufficiency from maternal hypertension and cardiac dysfunction. In general, prolonged nitroprusside use should be avoided, and the monitoring of maternal serum pH, plasma cyanide and thiocyanate, and methemoglobin levels are recommended if nitroprusside must be used. Animal data suggest that fetal cyanide toxicity may occur without maternal symptoms. Because of this, some experts recommend that nitroprusside be considered only for the treatment of hypertensive emergencies complicated by left ventricular failure and pulmonary edema that is refractory to hydralazine or diazoxide therapy.

Nitroprusside has been assigned to pregnancy category C by the FDA. Animal studies have shown that nitroprusside readily crosses the placenta. The infusion of nitroprusside 25 mcg per kg per min for one hour to pregnant ewes resulted in death in all fetuses, whereas ewes infused with 1 mcg per kg per min for one hour delivered normal lambs. There are no controlled data in human pregnancy. Nitroprusside should only be given during pregnancy when benefit outweighs risk.

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Nitroprusside Breastfeeding Warnings

There are no data on the excretion of nitroprusside into human milk. The manufacturer recommends that due to the potential for serious adverse reactions in nursing infants, a decision should be made to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

See references

References for pregnancy information

  1. "Product Information. Nipride (nitroprusside)." Roche Laboratories, Nutley, NJ.
  2. Wasserstrum N "Nitroprusside in preeclampsia." Hypertension 18 (1991): 79-84
  3. Bobier HS, Smith GN, Pancham SR, Brien JF "Comparative study of sodium nitroprusside induced vasodilation of human placental veins from premature and full-term normotensive and preeclamptic pregnancy." Can J Physiol Pharmacol 73 (1995): 1118-22
  4. Shoemaker CT, Meyers M "Sodium nitroprusside for control of severe hypertensive disease of pregnancy: a case report and discussion of potential toxicity." Am J Obstet Gynecol 149 (1984): 171-3

References for breastfeeding information

  1. "Product Information. Nipride (nitroprusside)." Roche Laboratories, Nutley, NJ.

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