| name | Sodium Nitroprusside |
| classification | Vasodilator, Antihypertensive |
| pharmacokinetics | | absorption | IV administration only, rapid onset, short duration of action (minutes). Metabolized rapidly to cyanide and thiocyanate. | | distribution | Distributed throughout the body. | | metabolism | Metabolized rapidly in the liver to cyanide and thiocyanate. | | excretion | Excreted primarily as thiocyanate in the urine. |
|
| suggested dosage | Intravenous infusion. Dosing is titrated to effect, typically starting at 0.5-10 mcg/kg/min. Closely monitored blood pressure is essential, and the infusion should be stopped immediately if signs of excessive hypotension occur. |
| patient specific considerations | | age | 25 years - typical dosage and pharmacokinetic parameters applicable, but careful monitoring is warranted. | | weight | 70 kg - dosage should be adjusted based on weight. Using mcg/kg/min is preferred. | | gender | No gender-specific considerations for this medication. |
|
| indications | | 1 | Hypertensive emergencies (e.g., malignant hypertension, hypertensive encephalopathy). | | 2 | Congestive heart failure with reduced ejection fraction and severe acute pulmonary edema. |
|
| safety in pregnancy | Use during pregnancy only if clearly needed and benefits outweigh risks. Close monitoring of mother and fetus is crucial, given the potential for cyanide and thiocyanate accumulation. |
| safety in breastfeeding | Not recommended due to potential for cyanide and thiocyanate excretion into breast milk. Alternatives should be considered if possible. |
| side effects | | 1 | Hypotension (most common), nausea, vomiting, headache, dizziness, anxiety, sweating, palpitations, methemoglobinemia (rare), cyanide toxicity (rare but serious) and thiocyanate toxicity (rare but cumulative). | | 2 | Important note: Side effects are often dose-dependent and closely monitored in clinical use. Any signs of cyanide toxicity (e.g. weakness, lethargy, dyspnea) or thiocyanate toxicity (e.g., dizziness, tinnitus, altered mental status) require immediate intervention by halting the infusion and supportive care. |
|
| alternatives | |
| contraindications | | 1 | Known hypersensitivity to sodium nitroprusside. | | 2 | Severe hypotension. | | 3 | Significant aortic stenosis (potential for excessive hypotension). | | 4 | Severe hepatic or renal insufficiency (caution required due to potential for accumulation and toxicity). |
|
| interactions | | 1 | May interact with other antihypertensive medications (additive hypotensive effects). | | 2 | Concurrent use of medications that increase cyanide concentration (e.g., certain antidepressants) may increase risk of cyanide toxicity. | | 3 | Concurrent administration of aminoglycoside antibiotics (or other compounds known to increase cyanide formation) or certain drugs that deplete vitamin B12, can potentially result in greater risk of cyanide and methemoglobinemia. |
|
| warnings and precautions | | 1 | Administration should be in a setting equipped for intensive care monitoring, with close monitoring of vital signs (especially blood pressure, heart rate, oxygen saturation, etc.) | | 2 | Patients with known or suspected renal or hepatic impairment require dosage adjustments and close monitoring of thiocyanate levels. | | 3 | Meticulous infusion rates, careful monitoring, and close clinical observation are mandatory. | | 4 | Infusion site needs to be monitored and changed if there are any issues. |
|
| additional information | | 1 | Use only in emergency situations, given the potential for serious side effects and need for close monitoring. | | 2 | Sodium nitroprusside is light sensitive; the solution should be protected from light. Ensure use of appropriate administration sets with correct tubing. | | 3 | Continuous electrocardiogram monitoring should be considered. Continuous blood pressure monitoring is required and essential. |
|
