Composition
Inj: Per ml: Sodium nitroprusside 25 mg; 2 ml (50 mg).
Indications & Dosage
Hypertensive emergencies: BY IV INF: Adult: Initially 0.5-1.5 mcg/kg/minute, adjusted in steps of 500 nanograms/kg/minute every 5 minutes, usual dose 0.5-8 mcg/kg/minute, use lower doses if already receiving other anti-hypertensives, stop if response unsatisfactory with max. dose in 10 minutes, lower initial dose of 300 nanograms/kg/minute has been used. Maintenance of blood pressure at 30-40% lower than pretreatment diastolic blood pressure: BY IV INF: Adult: 20-400 mcg/minute, use lower doses for patients being treated with other anti-hypertensives. Controlled hypotension in anaesthesia during surgery: BY IV INF: Adult: Up to 1.5 mcg/kg/minute. Acute or chronic heart failure: BY IV INF: Adult: Initially 10-15 mcg/minute, increased every 5-10 minutes as necessary; usual dose10-200 mcg/minute normally for max. 3 days.
Administration
For IV infusion only, use only as an infusion with 5% dextrose in water. Infusion pump required. Not for direct injection. Note: A blue colour indicates almost complete degradation & breakdown of cyanide. Solutions should be wrapped with aluminium foil or other opaque material to protect from light (do as soon as possible).
Compatibility
Stable in LR.
Stability
Store at 15C-30C (59o F-86F). If properly pro-tected from light, the freshly reconstituted and diluted solution is stable for 24 hours.
Contraindications
Severe vitamin B12 deficiency, Lebers optic atrophy, compensatory hypertension.
Precautions
Hypothyroidism, hyponatraemia, ischaemic heart disease, impaired cerebral circulation, elderly, hypothermia; monitor blood pressure and blood-cyanide concentration and if treatment exceeds 3 days, also blood-thiocyanate concentration; avoid sudden withdrawal, terminate infusion over 15-30 min; protect infusion from light.
Pregnancy
Caution advised
Lactation
Caution advised
Side Effects
Abdominal pain, acute transient phlebitis, anxiety, dizziness, headache, nausea, palpitation, perspiration, reduced platelet count, retching, retrosternal discomfort