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CARDIOVASCULAR SYSTEM › ANTIHYPERTENSIVES › ARTERIOLAR SMOOTH MUSCLE, AGENTS ACTING ON › Nitroferricyanide derivatives
nitroprusside
C02DD01
Forms & Strengths
- Injectable solution: 25 mg/mL, 50 mg/mL in 2 mL vials
- Reconstituted infusion: 50 mg/250 mL D5W
Adult Dosing
- Hypertensive emergency: Initial 0.3 to 0.5 mcg/kg/min IV infusion
- Titration: Increase by 0.5 mcg/kg/min every few minutes
- Maintenance: Average 3 mcg/kg/min
- Maximum dose: 10 mcg/kg/min for maximum 10 minutes
Pediatric Dosing
- Hypertensive crisis: Initial 0.3 to 0.5 mcg/kg/min IV infusion
- Titration and maintenance: Same as adult dosing based on weight
- Maximum dose: 10 mcg/kg/min
Indications
- Hypertensive emergencies
- Controlled hypotension to reduce bleeding during surgery
- Acute heart failure with reduced ejection fraction and elevated filling pressures
Mechanism of Action
- Direct-acting peripheral vasodilator affecting both resistance and capacitance vessels
- Spontaneously releases nitric oxide (NO) which activates guanylyl cyclase
- Increases intracellular cyclic GMP, leading to smooth muscle relaxation
Contraindications
- Compensatory hypertension (e.g., arteriovenous shunt, coarctation of the aorta)
- Congenital optic atrophy or tobacco amblyopia
- Acute heart failure associated with systemic vascular resistance (SVR) reduction alone
- Known hypersensitivity to sodium nitroprusside
Adverse Reactions
- Severe hypotension with reflex tachycardia
- Cyanide toxicity (metabolic acidosis, confusion, dyspnea)
- Thiocyanate toxicity (fatigue, tinnitus, psychosis)
- Methemoglobinemia
- Nausea, abdominal pain, headache, diaphoresis
Drug Interactions
- Additive hypotensive effects with antihypertensive agents, anesthetics, and phosphodiesterase-5 inhibitors
- Concomitant administration with sodium thiosulfate decreases risk of cyanide toxicity
- Ganglionic blockers and general anesthetics potentiate the hypotensive response
Curated Content: Needs Vetting Before Put to Clinical Use