- Sodium nitroprusside is primarily used as a potent vasodilator.
- Works predominantly in arterioles and venules as a result of its breakdown to nitric oxide (NO).
- Nitric oxide reduces both total peripheral resistance and venous return, thus decreasing both preload and afterload
- Thiocyanate level when checking for toxicity
- Start 0.5 mcg/kg/min IV, increasing 0.5 mcg/kg/min q5 min
- Usual dosage 3-4 mcg/kg/min IV
- Max dose 10 mcg/kg/min for 10 min
- Start 0.3 mcg/kg/min IV, max 10 mcg/kg/min for 10 min
- ICH - theoretical concern for raising ICP via cerebral vasodilation, consider nicardipine instead
- Aortic coarctation
- Arteriovenous shunt
- Existing cyanide toxicity
- High output heart failure
- Lack of arterial line monitoring
Maximum Dose Rate
- Infusion at maximum dose rate of 10 mcg/kg/min should never last for more than 10 minutes
- If blood pressure is not controlled after 10 minutes of infusion at max rate, immediately terminate infusion
- Hypertensive emergency
- CHF, low output
Mechanism of Action
Potent arteriolar dilation from its active metabolite, nitric oxide (NO).
Adverse Drug Reactions
- Cyanide and thiocyanate metabolites potentially toxic
- Metabolized via liver CYP450, excreted via urine
- Half life 2 min
- However, thiocyanate half life is 3 days
- ↑ "nitroprusside sodium (Rx) - Nipride, Nitropress, more..". Medscape Reference. WebMD. Retrieved 20 November 2013.
- ↑ Suri MF et al. A multicenter comparison of outcomes associated with intravenous nitroprusside and nicardipine treatment among patients with intracerebral hemorrhage. Neurocrit Care. 2009;11(1):50-5. doi: 10.1007/s12028-009-9192-1. Epub 2009 Feb 18.