Sodium nitroprusside


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Hypertensive crisis For patients not receiving any antihypertensives: Initial: 0.3-1.5 mcg/kg/min, adjust gradually as needed. Usual: 0.5-6 mcg/kg/min. Max rate: 8 mcg/kg/min, discontinue if there is no response after 10 mins. May continue for a few hr if there is response. Introduce PO as soon as possible. Lower doses should be used in patients receiving antihypertensives. Induction of hypotension during anesth Recommended max: 1.5 mcg/kg/min. Heart failure Intial: 10-15 mcg/min, may increase if needed. Usual: 10-200 mcg/min. Max: 280 mcg/min.
Dosage Details
Intravenous
Heart failure
Adult: Initially 10-15 mcg/min, may increase by 10-15 mcg/min every 5-10 min according to response. Usual dose range: 10-200 mcg/min. Max: 280 mcg/min.

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 minutes. May continue for a few hours if there is response. Introduce oral antihypertensive as soon as possible.
Elderly: Lower doses may be required.

Intravenous
Induction of hypotension during anaesthesia
Adult: Recommended max dose: 1.5 mcg/kg/min.
Renal Impairment
Dosage adjustments may be necessary.
Contraindications
Hypersensitivity, compensatory hypertension.
Special 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).
IV/Parenteral: C
Overdosage
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.
Action
Description: 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.
Pharmacokinetics:
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
Store at 20-25°C.
Disclaimer: This information is independently developed by MIMS based on Sodium nitroprusside from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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