Classes
DEA Class; Rx
Common Brand Names; Nipride RTU, Nitropress, Sodium Nitroprusside
- Vasodilators
Description
Used for treatment of hypertensive crises, induction and maintenance of controlled hypotension during surgery, and treatment of acute heart failure
Use limited by the potential for cyanide and/or thiocyanate toxicity
Indications
Indicated for immediate reduction of blood pressure (BP) during hypertensive crisis
Indicated for induction and maintenance of controlled hypotension during surgery, to reduce bleeding
Indicated for treatment of acute heart failure to reduce left ventricular end-diastolic pressure, pulmonary capillary wedge pressure, peripheral vascular resistance, and mean arterial blood pressure
Treatment and prevention of cerebral vasospasm following subarachnoid hemorrhage
Contraindications
Hypersensitivity
Compensatory HTN (eg, arteriovenous shunt or aortic coarctation); (for controlled hypotension): inadequate cerebral circulation
Certain rare conditions, eg, congenital optic atrophy, tobacco amblyopia
Treatment of acute CHF associated with reduced peripheral vascular resistance such as high-output heart failure that may be seen in endotoxic sepsis
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
Adverse Effects
Common
Bradyarrhythmia, hypotension, palpitations, tachyarrhythmia
Apprehension, restlessness, confusion, dizziness, headache, somnolence
Rash, sweating
Thyroid suppression
Injection site irritation
Muscle twitch
Oliguria, renal azotemia
Serious
Cardiac dysrhythmia, hemorrhage, decreased platelet aggregation, excessive hypotensive response
Raised intracranial pressure
Metabolic acidosis
Bowel obstruction
Methemoglobinemia
Cyanide poisoning
Thiocyanate toxicity
Warnings
Small transient excesses in the infusion rate of sodium nitroprusside can result in excessive hypotension, sometimes to levels so low as to compromise the perfusion of vital organs; nitroprusside-induced hypotension will be self-limited within 1-10 minutes after discontinuation of therapy; during these few minutes, it may be helpful to put the patient into a head-down (Trendelenburg) position to maximize venous return; if hypotension persists more than a few minutes after discontinuation of infusion therapy is not the cause, and the true cause must be sought
Therapy can cause increases in intracranial pressure; in patients whose intracranial pressure is already elevated, sodium nitroprusside should be used only with extreme caution
Use caution when administering nitroprusside to patients with hepatic insufficiency
When sodium nitroprusside (or any other vasodilator) is used for controlled hypotension during anesthesia, the patient’s capacity to compensate for anemia and hypovolemia may be diminished; if possible, pre-existing anemia and hypovolemia should be corrected prior to administration of therapy
Hypotensive anesthetic techniques may cause abnormalities of pulmonary ventilation/perfusion ratio; patients intolerant of these abnormalities may require a higher fraction of inspired oxygen
Head trauma, increases ICP, hyponatremia, hypothyroidism, severe hepatic or renal impairment, elderly
Pregnancy and Lactation
Pregnancy Category: C
Lactation: controversial; excreted in breast milk, not recommended for long term use if breastfeeding
Maximum Dosage
10 mcg/kg/minute IV for 10 minutes.
10 mcg/kg/minute IV for 10 minutes.
10 mcg/kg/minute IV for 10 minutes.
10 mcg/kg/minute IV for 10 minutes.
10 mcg/kg/minute IV for 10 minutes.
10 mcg/kg/minute IV for 10 minutes.
How supplied
Nitroprusside sodium
injectable solution
Nitropress
- 25mg/mL (50mg/2mL vial) (Nitropress)
Nipride RTU
- 0.2mg/mL (20mg/100mL 0.9% NaCl)
- 0.5mg/mL (50mg/100mL 0.9% NaCl)