Nitroprusside Sodium Uses/Indications Dosage Side effects- DrugsAce

Classes

DEA Class; Rx

Common Brand Names; Nipride RTU, Nitropress, Sodium Nitroprusside

Vasodilators

Intravenous direct-acting vasodilator
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