Nitroprusside

Nitroprusside

DrugNitroprusside
Brand namesNipride ®, Nipride RTU ®, Nitropress ®.
IndicationsPulmonary edema, congestive heart failure.
Angina pectoris.
Hypertension, hypertensive crisis/emergency.
Pulmonary hypertension.
Blood pressure control.
Mechanism of actionNitroprusside provides nitric oxide (NO) that induces vasodilatation of both arterioles and veins via generation of cyclic GMP, which then activates calcium-sensitive potassium channels in the cell membrane.
Time to onset of action: 1 minute.
Duration of action: <10 minutes.
EffectsPotent blood pressure lowering.
Antianginal effect.
Reduces afterload and preload.
Effective in pulmonary edema.
Can produce severe hypotension.
Time to onset of action30 seconds to 1 minute
Duration of action1 to 10 minutes
DeliveryIV
DoseInfusion:
Starting dose: 0.25 to 0.5 μg/kg/minute.
Increased as necessary (increments of 0.5 μg/kg/min).
Maximum dose: 8-10 μg/kg/minute.
Common maximum dose: 3 μg/kg/minute.
Maximum dose (10 μg/kg/minute) should never be used for mor than 10 minutes.
Administer sodium thiosulfate (cyanide into thiocyanate) and terminate infusion of nitroprusside if cyanide toxicity is suspected.
Adverse effects• Nausea. Vomiting. Agitation. Muscle spasm. Sweating. Flushing.
• Prolonged high-dose use may cause thiocyanate and cyanide toxicity. Nitroprusside is metabolized to cyanide. Cyanid toxicity may be fatal (should be suspected if patient develops altered mental status and lactic acidosis). Fatal outcomes are rare. Renal failure increases risk of cyanide toxicity. Cyanide toxicity requires doses >2 μg/kg/minute. Use the lowest possible dose, avoiding prolonged use (<2-3 days), and monitor the patient closely to avoid cyanide toxicity.
• Dose-dependent reduction in coronary and renal perfusion.
• Dose-dependent elevation of intracranial pressure (ICP) and reduction in cerebral blood flow.
Caution• Used cautiously in patients with high intracranial pressure or azotemia.
• Should not be given to pregnant women.
• Should not be given to patients with Leber optic atrophy.
Nitroprusside doses and administration in hypertension (hypertensive crisis/emergency).
Updated on 2025-01-18