Drug Index

Nitroprusside

Synonyms :

Nitroferricyanide, Sodium Nitroprusside

Mechanism :

Peripheral vasodilation by direct action on venous and arteriolar smooth muscle thus reducing peripheral resistance; will increase cardiac output by decreasing afterload, reduces aortal and left ventricular impedance.


Indication :

  • Management of hypertensive crisis
  • CHF
  • Controlled hypotension during surgery
  • Angina

Contraindications :

Hypersensitivity, Decreased cerebral perfusion, Arteriovenous shunt or coarctation of aorta.


Dosing :

IV continuous infusion:
Start 0.3-0.5 mcg/kg/min titrate upwards (usual dose: 3 mcg/kg/min, maximum dose 8-10 mcg/kg/min).

Adverse Effect :

Excessive hypotension, palpitations, substernal distress, tachyarrhythmia, restlessness, disorientation, psychosis, headache, elevated intracranial pressure, thyroid suppression, metabolic acidosis, nausea, vomiting, bowel obstruction, thiocyanate toxicity, neuromuscular & skeletal weakness, muscle twitch, diaphoresis, cyanide toxicity, rash, injection site irritation, oliguria, azotemia.


Interaction :

Alteplase: IV nitroglycerin may decrease the effect of alteplase.
Avanafil: Additive vasodilation. Concomitant therapy is contraindicated.
Azilsartan medoxomil: Pharmacodynamic synergist- increases effects.
Dihydroergotamine: Possible antagonism of action.
Ergonovine: Possible antagonism of action.
Ergotamine: Possible antagonism of action.
Methylergometrine: Possible antagonism of action.
Methysergide: Possible antagonism of action.
Sildenafil: Possible significant hypotension with this combination.
Tadalafil: The vasodilatory effects of Nitroglycerin may be increased by Tadalafil. Severe hypotension may occur. Concomitant therapy is contraindicated.
Treprostinil: Additive hypotensive effect. Monitor antihypertensive therapy during concomitant use.
Udenafil: The vasodilatory effects of Nitroglycerin may be increased by Udenafil. Severe hypotension may occur. Concomitant therapy is contraindicated.
Vardenafil: The vasodilatory effects of Nitroglycerin may be increased by Vardenafil. Severe hypotension may occur. Concomitant therapy is contraindicated.



Renal Dose :

Dose in Renal Impairment GFR (mL/min)
20-50Dose as in normal renal function
10-20Dose as in normal renal function. Avoid prolonged use
<10Dose as in normal renal function. Avoid prolonged use

Dose in Patients undergoing Renal Replacement Therapies
CAPDDialysed. Dose as in GFR<10 mL/min
HDDialysed. Dose as in GFR<10 mL/min
HDF/High fluxDialysed. Dose as in GFR<10 mL/min
CAV/VVHDUnknown dialysability. Dose as in GFR=10–20 mL/min

Hepatic Dose :

Nitroprusside is metabolized in the liver so use with caution. Since cyanide is metabolized by hepatic enzymes, it may accumulate in patients with severe hepatic impairment.
07/08/2024 10:40:16 Nitroprusside
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