Sodium Nitroprusside

Indications
 Intravenous
Hypertensive crisis
Adult: For patients not receiving any antihypertensives, initially 0.3-1.5 mcg/kg/min, adjust gradually according to response. Usual range 0.5-6 mcg/kg/min. Lower doses should be used in patients receiving antihypertensives. Max rate: 8 mcg/kg/min, discontinue infusion if there is no response after 10 min. May continue for a few hr if there is response. Introduce oral antihypertensive as soon as possible.
Child: Initially, 250-500 nanograms/kg/min, rate may be repeatedly doubled at intervals of 15-20 min until the desired effect is achieved or treatment is judged ineffective. Max rate: 6 mcg/kg/min.
Elderly: Lower doses may be required.
Renal impairment: Dosage adjustments may be necessary.
Intravenous
Induction of hypotension during anaesthesia
Adult: Recommended max dose: 1.5 mcg/kg/min.
Renal impairment: Dosage adjustments may be necessary.
Intravenous
Heart failure
Adult: Intially 10-15 mcg/min, may increase by 10-15 mcg/min every 5-10 min according to response; usual range 10-200 mcg/min. Max: 280 mcg/min.
Renal impairment: Dosage adjustments may be necessary.
Contraindications
 Hypersensitivity, compensatory hypertension.
Warnings / Precautions
 Hypothyroidism, renal and hepatic impairment, ischaemic heart disease, impaired cerebral circulation, elderly. Monitor blood thiocyanate concentration if treatment is longer than 3 days and should not exceed 100 mcg/ml. Monitor acid-base balance, venous oxygen concentration and BP. Caution to avoid extravasation. To be diluted with sterile dextrose 5% solution before infusion. Avoid sudden withdrawal. Leber's optic atrophy, low plasma-cobalamin concentrations, impaired pulmonary function. Pregnancy and lactation.
Adverse Reactions
 Nausea, retching, apprehension, headache, restlessness, muscle twitching, retrosternal discomfort; palpitation, dizziness, abdominal discomfort. Cyanosis and hypothyroidism (rare).
Overdose Reactions
 Overdosage may result in excessive hypotension, cyanide or thiocyanate toxicity.
Drug Interactions
 Additive effect when used with other antihypertensives. May prolong the fibrinolytic activity of alteplase. Risk of severe hypotension if used with phosphodiesterase inhibitors. May reduce serum digoxin levels.
See Below for More sodium nitroprusside Drug Interactions
Mechanism of Actions
 Sodium nitroprusside is a short-acting antihypertensive that acts directly on the venous and arteriolar smooth muscle causing peripheral vasodilation, thus decreasing peripheral resistance. It is also used to reduce preload and afterload in severe heart failure.
Metabolism: Rapidly metabolised to cyanide in red blood cells and smooth muscle, leading to release of nitric oxide.
Excretion: Cyanide is further metabolised hepatically to thiocyanate and excreted in the urine. Plasma half-life of thiocyanate is about 3 days.
Storage Conditions
 Intravenous: Store at 20-25°C.
Storage
 Intravenous: Store at 20-25°C.
Available As
  • Sodium Nitroprusside 50 mg

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