Nitroprusside Sodium(nye troe pruss’ ide)
Nipride (CAN), Nitropress
PREGNANCY CATEGORY C
Drug Classes
Antihypertensive
Vasodilator
Therapeutic Actions
Acts directly on vascular smooth muscle to cause vasodilation (arterial and venous) and reduce BP. Mechanism involves interference with calcium influx and intracellular activation of calcium. CV reflexes are not inhibited and reflex tachycardia, increased renin release occur.
Indications
Hypertensive crises for immediate reduction of BP
Production of controlled hypotension during anesthesia to reduce bleeding in surgical procedures
Acute HF
Unlabeled uses: Acute MI, with dopamine; left ventricular failure, with oxygen, morphine, loop diuretic
Contraindications and Cautions
Contraindicated with treatment of compensatory hypertension; to produce controlled hypotension during surgery with known inadequate cerebral circulation; emergency use in moribund patients; acute HF with peripheral vascular disease.
Use cautiously with hepatic, renal insufficiency (drug decomposes to cyanide, which is metabolized by the liver and kidneys to thiocyanate ion); hypothyroidism (thiocyanate inhibits the uptake and binding of iodine); pregnancy; lactation.
Available Forms
Powder for injection—50 mg/vial
Dosages
Administer only by continuous IV infusion with sterile D5W.
Adults and pediatric patients
In patients not receiving antihypertensive medication, the average dose is 3 mcg/kg/min (range 0.3–10 mcg/kg/min). At this rate, diastolic BP is usually lowered by 30%–40% below pretreatment diastolic levels. Use smaller doses in patients on antihypertensive medication. Do not exceed infusion rate of 10 mcg/kg/min. If this rate of infusion does not reduce BP within 10 min, discontinue administration.
Geriatric patients or patients with renal impairment
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