Parenteral Manual

Nitroprusside sodium (SPECIAL ACCESS PROGRAM)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
NITROPRESS
Classification: 
Antihypertensive
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • 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
Reconstitution and Stability: 
  • 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.

 

Compatibility: 

- 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

 

 

Administration: 

(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
IV infusion only -must be diluted

Standard Concentration in ER/OR/PICU:  200 mcg/mL and 1000 mcg/mL

Click here to access SDC Drug Infusion Sheet

Dosage: 

(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
Potential hazards of parenteral administration: 
  • 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
Notes: 
  • 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

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