Nitroprusside Sodium

Nitroprusside Sodium is a prescription medication used to treat Hypertensive Crisis, Controlled Hypotension During Surgery, and Acute Heart Failure. 

• Nitroprusside Sodium is available under the following different brand names: Nipride RTU, Nitropress, Sodium Nitroprusside.

• Adult and pediatric dosage

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)

Hypertensive Crisis

Adult and pediatric dosage

• Initial infusion rate: 0.3 mcg/kg/min; evaluate BP for at least 5 minutes before titrating to a higher or lower dose to achieve desired BP
• Not to exceed 10 mcg/kg/min

Controlled Hypotension During Surgery

Adult and pediatric dosage

• Initial infusion rate: 0.3 mcg/kg/min; evaluate BP for at least 5 minutes before titrating to a higher or lower dose to achieve desired BP
• Not to exceed 10 mcg/kg/min

Acute Heart Failure

Adult dosage

• Initial infusion rate: 0.3 mcg/kg/min; evaluate BP for at least 5 minutes before titrating to a higher or lower dose to achieve desired BP
• Not to exceed 10 mcg/kg/min

Dosage Considerations – Should be Given as Follows: 

• See "Dosages."

Common side effects of Nitroprusside Sodium include:

• flushing (sudden warmth, redness, or tingly feeling), and 
• bruising or irritation around the IV needle 

Serious side effects of Nitroprusside Sodium include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• lightheadedness, 
• chest pain, 
• severe shortness of breath, 
• pounding heartbeats, 
• sweating, 
• restlessness or uneasy feeling, 
• weakness, 
• tiredness, 
• stomach pain, 
• nausea, 
• vomiting, 
• headache, 
• confusion, 
• ringing in the ears, 
• muscle pain or twitching, 
• problems with muscle movement, 
• numb or cold feeling in the arms and legs, and 
• blue colored lips, fingers, or toes

Rare side effects of Nitroprusside Sodium include:

• none 

This is not a complete list of side effects and other serious side effects or health problems may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Nitroprusside Sodium has severe interactions with no other drugs.
• Nitroprusside Sodium has serious interactions with the following drugs:
  • avanafil
  • lofexidine 
• Nitroprusside Sodium has moderate interactions with at least 22 other drugs.
• Nitroprusside Sodium has minor interactions with no other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

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

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Nitroprusside Sodium?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Nitroprusside Sodium?”

Cautions

• 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
• Cyanide toxicity
  • Infusions at rates above 2 mcg/kg/min generate cyanide ion (CN¯) faster than the body can normally dispose of it
  • Methemoglobin normally present in the body can buffer a certain amount of CN¯, but the capacity is exhausted by the CN¯ produced from about 500 mcg/kg of sodium nitroprusside; this amount of sodium nitroprusside is administered in less than an hour when the drug is administered at 10 mcg/kg/min (the maximum recommended rate); thereafter, the toxic effects of CN¯ may be rapid, serious, and even lethal
  • Cyanide toxicity may manifest itself as venous hyperoxemia with bright red venous blood, as cells become unable to extract oxygen delivered to them; metabolic (lactic) acidosis; air hunger; confusion; and death
  • Cyanide toxicity due to causes other than nitroprusside has been associated with angina pectoris and myocardial infarction; ataxia, seizures, and stroke; and other diffuse ischemic damage
  • Hypertensive patients, and patients concomitantly receiving other antihypertensive medications, may be more sensitive to the effects of sodium nitroprusside than normal subjects
  • Check thiocyanate levels, monitor pulse oximeter
  • Thiocyanate clearance may decrease with renal failure
• Drug interaction overview
  • The hypotensive effect of sodium nitroprusside is augmented by that of most other hypotensive drugs, including ganglionic blocking agents, negative inotropic agents, and inhaled anesthetics

Pregnancy and Lactation

• Use with caution if benefits outweigh risks during pregnancy. 
• Lactation: not known if distributed into milk.