- Treatment of acute hypertension refractory to standard therapeutic measures especially those associated with acute left ventricular failure
- Has been used with inotropes for treatment of severe congestive heart failure and cardiogenic shock for preload and afterload reduction
- Main effects are peripheral vasodilation
- Supplied as 25 mg/mL solution in 2 mL vials
- Store vials at room temperature in carton until used
- Solutions diluted in D5W are stable for at least 24 hours when protected from light
-
Freshly prepared solutions have a faint brownish tint. Highly discoloured solutions should be discarded (e.g. blue, green, dark red)
Protect from light (cover with enclosed light protective sleeve or other opaque material -aluminum foil). It is not necessary to cover tubing.
Nitroprusside 200 mcg/mL:
- Draw up 10 mg (0.4 mL) of nitroprusside 25 mg/mL and add to 49.6 mL of D5W
Nitroprusside 1000 mcg/mL:
- Draw up 50 mg (2 mL) nitroprusside 25 mg/mL and add to 48 mL of D5W
- Solutions Compatible: D5W
- Additive/Above Cassette Compatible: caffeine, heparin
- Y-site Compatible: calcium chloride, dopamine, dobutamine, epinephrine, isoproterenol, labetalol, lidocaine, KCl, magnesium sulfate, midazolam, milrinone, morphine, nitroglycerin, norepinephrine, pancuronium, procainamide, propafenone, ranitidine, SMOF Lipid 20%, TPN (amino acids/dextrose), vecuronium
- Incompatible: levofloxacin
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM | NO |
| IV Direct |
NO |
| IV Intermittent Infusion |
NO |
| IV Continuous Infusion |
YES, cardiac monitoring, continuous BP monitoring |
Click here to access SDC Drug Infusion Sheet
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
Pediatric/Adult:
- Start with 0.3-0.5 microgram/kg/minute IV and titrate every few minutes to effect.
- Usual dose is 3 microgram/kg/minute (rarely >4 mcg/kg/minute)
- Maximum dose: 8-10 microgram/kg/minute
- Hypotension
- Rapid IV - nausea, vomiting, diaphoresis, headache, restlessness, agitation, muscle twitching, chest pain, abdominal pain, palpitations, dizziness and rash. Symptoms disappear rapidly on slowing infusion rate or temporarily discontinuing
- Continuous monitoring of blood pressure and the flow rate are essential
- Monitor cyanide and thiocyanate levels if used in high doses (>4 mcg/kg/minute) for longer than 3 days or in patients with renal impairment. Keep thiocyanate levels <0.8 mmol/L
- Nitroprusside is metabolized to thiocyanate. Excessive doses of nitroprusside can lead to cyanide intoxication (eg: profound hypotension, reflex tachycardia, metabolic acidosis, methemoglobinemia, coma). Normal cyanide levels = <0.2 mcg/mL (smoker <0.4 mcg/mL).
- Antidote: sodium nitrite; sodium thiosulfate
- Onset of action: 0.5-2 minutes
- Wean slowly as acute withdrawal may result in hypertensive crisis
- Use with caution in patients with hypothyroidism, hyponatremia, increased intracranial pressure and patients with severe renal or hepatic impairment