| name | Sodium Nitroprusside |
| classification | Vasodilator, Antihypertensive |
| pharmacokinetics | Nitroprusside is rapidly metabolized in the body, primarily by red blood cells, to cyanide, which is further converted to thiocyanate. It has a very short half-life (approximately 1-4 minutes), requiring intravenous administration for immediate and short-lived effects. The metabolites, not the drug itself, are excreted in the urine. |
| suggested dosage | Sodium nitroprusside is administered intravenously only under strict medical supervision. Dosage is titrated based on the patient's blood pressure response. Continuous and close blood pressure monitoring is crucial. A starting dose might be 0.5-10 mcg/kg/min, gradually increased. Specific amounts and durations are determined individually by a physician based on the patient's unique situation. |
| indications | Sodium nitroprusside is primarily used for hypertensive emergencies, where blood pressure requires immediate lowering, such as hypertensive crisis, acute heart failure, and aortic dissection. It can also be used for controlling blood pressure during surgical procedures. Due to its short duration and metabolic byproducts, it should not be used for long-term blood pressure management. |
| safety in pregnancy | Use during pregnancy is considered only when benefits outweigh risks. It's generally not a first-line choice due to potential risks to the developing fetus. A specialist should assess risks and benefits in each case. Metabolism to cyanide may accumulate in the mother and pose risks to the fetus. Data is limited. |
| safety in breastfeeding | Not recommended. Potential adverse effects on the nursing infant due to cyanide/thiocyanate excretion are a concern. Alternatives should be considered. Discontinuation of breastfeeding may be necessary. Consult with a specialist. |
| side effects | | 1 | Hypotension | | 2 | Cyanide toxicity (rare, but serious) | | 3 | Thiocyanate toxicity (rare, but cumulative) | | 4 | Headache | | 5 | Nausea | | 6 | Vomiting | | 7 | Lightheadedness | | 8 | Restlessness | | 9 | Muscle twitching | | 10 | Rapid heart rate | | 11 | Dyspnea | | 12 | Metabolic acidosis | | 13 | Elevated serum creatinine |
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| alternatives | |
| contraindications | | 1 | Known hypersensitivity to sodium nitroprusside or its components | | 2 | Severe liver or kidney dysfunction | | 3 | Known cyanide poisoning | | 4 | Conditions where rapid blood pressure reduction may be harmful (e.g., certain types of shock) |
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| interactions | Concurrent use with certain drugs can exacerbate side effects. Consult with the prescribing physician if the patient is taking other medications. Some drugs can impact nitroprusside metabolism, affecting required dosages. |
| warnings and precautions | | 1 | Continuous blood pressure monitoring is essential during administration. | | 2 | Close monitoring of serum cyanide and thiocyanate levels. | | 3 | Avoid use in patients with known or suspected cyanide poisoning. | | 4 | Use with caution in patients with pre-existing cardiovascular disease. |
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| additional informations | Requires careful administration in a controlled environment (e.g., hospital or intensive care unit). Close monitoring for potential adverse effects is critical due to rapid metabolism. |
| patient specific notes | Age and weight are not the sole determinants of initial dosage. Dosage is adjusted based on blood pressure response and other clinical factors. This is a highly potent and potentially dangerous drug, requiring administration only by healthcare professionals knowledgeable in its use. |
