II. Indications
-
Hypertensive Emergency
- Nicardipine is now preferred instead for Hypertensive Emergency
- Reduces Blood Pressure rapidly
- However difficult to titrate due to a wide variation in bloold pressure variation
- Well tolerated
- Easily reversed by discontinuing infusion
-
Congestive Heart Failure with pulmonary congestion
- Refractory to Diuretics
- Often used in combination with Dopamine
- Similar net effect to Dobutamine
- Nitroglycerin is preferred in Coronary Artery Disease
III. Mechanism: Potent peripheral vasodilation
- Effects arterial and venous smooth muscle
- Reduces arterial Blood Pressure
- Reduces peripheral arterial resistance
- Increases venous capacitance
- Decreases Preload
- Risk of reflex Tachycardia
IV. Metabolism
- Metabolites include Cyanide and Thiocyanate
- Hepatic dysfunction can allow Cyanide build-up
- Red Blood Cells metabolize to Hydrocyanic acid
- Liver converts to thiocyanate
- Renal Excretion
V. Pharmacokinetics
- Very short half-life
- Effects are seen almost immediately on infusion
- Effects cease as soon as infusion is stopped
VI. Dosing
- Preparation
- Reconstitute 50-100 mg powder in 2-3 ml D5W
- Dilute with 250 ml D5W or Normal Saline
- Final Concentration: 200-400 ug/ml
- Additional Measures
- Wrap solution immediately in aluminum foil
- Prevents deterioration under light exposure
- Use solution immediately after making it
- Discard solution if becomes highly colored
- Solution with faint brown tint is still usable
- Wrap solution immediately in aluminum foil
- Infusion
- Start 0.1 ug/kg/min
- Titrate 0.5 to 8.0 ug/kg/min
- Carefully monitor hemodynamic parameters
- Use lower doses in elderly
VII. Precautions
-
Hypotension may precipitate secondary events
- Myocardial Ischemia or Myocardial Infarction
- Cerebral Vascular accident
- Avoid Nitroprusside in Coronary Artery Disease
- Use Nitroglycerin instead
- Thiocyanate Intoxication
- Rarely seen unless:
- Nitroprusside doses over 3 ug/kg/min
- Prolonged Nitroprusside infusion over 2-3 days
- Renal Failure
- Monitor blood thiocyanate level
- Levels below 10 mg/100 ml are safe
- Signs of thiocyanate Intoxication
- Tinnitus
- Blurred Vision
- Altered Level of Consciousness
- Nausea
- Abdominal Pain
- Hyperreflexia
- Seizure disorder
- Rarely seen unless:
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| Definition (MSH) | A powerful vasodilator used in emergencies to lower blood pressure or to improve cardiac function. It is also an indicator for free sulfhydryl groups in proteins. |
| Definition (CSP) | powerful vasodilator used in emergencies to lower blood pressure or to improve cardiac function, also used as an indicator for free sulfhydryl groups in proteins. |
| Concepts | Pharmacologic Substance (T121) , Inorganic Chemical (T197) |
| MSH | D009599 |
| SnomedCT | 372860000, 8163008 |
| LNC | LP19169-9, MTHU007482 |
| English | Cyanonitrosylferrate, Nitroferricyanide, Nitroprusside, nitroferricyanide, Ferrate(2-), pentakis(cyano-C)nitrosyl-, (OC-6-22)-, nitroprusside, Nitroprusside [Chemical/Ingredient], NITROPRUSSIDE, Nitroprusside (product), Nitroprusside (substance) |
| Swedish | Nitroprussid |
| Czech | nitroprusid |
| Finnish | Nitroprussidi |
| Russian | NITROPRUSSID, NATRIIA NITROPRUSSID, NITROFERRITSIANID, НАТРИЯ НИТРОПРУССИД, НИТРОПРУССИД, НИТРОФЕРРИЦИАНИД |
| Japanese | ニトロフェリシアニド, ソジウムニトロプルシド, ニトロプルシド |
| Polish | Nitroprusydek |
| Croatian | NITROPRUSID |
| Spanish | nitroprusiato (producto), nitroprusiato (sustancia), nitroprusiato, Nitroferricianida, Nitroprusiato |
| French | Nitroprussiate |
| German | Nitroferricyanid, Cyanonitrosylferrat, Nitroprussid |
| Italian | Nitroprussito |
| Portuguese | Nitroferricianida, Nitroprussiato |
Ontology: Nipride (C0591866)
| Concepts | Pharmacologic Substance (T121) , Inorganic Chemical (T197) |
| MSH | D009599 |
| English | nipride, Nipride, Faulding Brand of Sodium Nitroprusside, Roche Brand of Sodium Nitroprusside |
