Sodium Nitropress Nitroprusside
- Generic Name: sodium nitroprusside for injection
- Brand Name: Sodium Nitroprusside (Nitropress) Injection
Sodium Nitroprusside (Nitropress) Injection (Sodium Nitroprusside for Injection) side effects drug center
Sodium Nitropress Nitroprusside Side Effects Center
What Is Sodium (Nitropress) Nitroprusside?
Sodium nitroprusside is an antihypertensive drug indicated for the immediate reduction of blood pressure of adult and pediatric patients in hypertensive crises. Concomitant longer-acting antihypertensive medication should be administered so that the duration of treatment with sodium nitroprusside can be minimized. Sodium nitroprusside is also indicated for producing controlled hypotension in order to reduce bleeding during surgery, and for the treatment of acute congestive heart failure. Sodium nitroprusside is available in generic form.
What Are Side Effects of Sodium (Nitropress) Nitroprusside?
Common side effects of sodium nitroprusside include:
- excessive low blood pressure,
- abdominal pain,
- apprehension,
- sweating,
- dizziness,
- headache,
- muscle twitching,
- nausea,
- palpitations,
- restlessness,
- retching,
- chest discomfort,
- slow or fast heart rate,
- rash,
- flushing, or
- irritation at the infusion site.
Dosage for Sodium (Nitropress) Nitroprusside
The dose and infusion rate of sodium nitroprusside is based on the patient's age, body weight, and the condition being treated.
What Drugs, Substances, or Supplements Interact with Sodium (Nitropress) Nitroprusside?
Sodium nitroprusside may interact with other antihypertensive drugs, including ganglionic blocking agents, negative inotropic agents, and inhaled anesthetics. Tell your doctor all medications and supplements you use.
Sodium (Nitropress) Nitroprusside During Pregnancy and Breastfeeding
Tell your doctor if you are pregnant or plan to become pregnant before using sodium nitroprusside; it is unknown how it might affect a fetus. It is unknown if sodium nitroprusside passes into breast milk. Breastfeeding while using sodium nitroprusside is not recommended.
Additional Information
Our Sodium Nitroprusside Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
Sodium Nitropress Nitroprusside Consumer Information
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Tell your caregivers at once if you have a serious side effect such as:
- feeling like you might pass out, even while lying down;
- gasping, struggling to breathe, or shallow breathing;
- confusion, ringing in your ears;
- dizziness with nausea and vomiting, rapid breathing, seizure (convulsions);
- fast, slow, or uneven heart rate;
- numb or cold feeling in your arms and legs; or
- chills, sweating, tremors, twitching, overactive reflexes.
Less serious side effects may include:
- mild skin rash;
- mild stomach pain or nausea;
- warmth, redness, or tingly feeling under your skin;
- darkening or deeper color of veins through your skin; or
- irritation around the IV needle.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Sodium Nitropress Nitroprusside (Sodium Nitroprusside for Injection)
Sodium Nitropress Nitroprusside Professional Information
SIDE EFFECTS
The most important adverse reactions to sodium nitroprusside are the avoidable ones of excessive hypotension and cyanide toxicity, described above under WARNINGS. The adverse reactions described in this section develop less rapidly and, as it happens, less commonly.
Methemoglobinemia
As described in CLINICAL PHARMACOLOGY above, sodium nitroprusside infusions can cause sequestration of hemoglobin as methemoglobin. The back-conversion process is normally rapid, and clinically significant methemoglobinemia (>10%) is seen only rarely in patients receiving sodium nitroprusside. Even patients congenitally incapable of back-converting methemoglobin should demonstrate 10% methemoglobinemia only after they have received about 10 mg/kg of sodium nitroprusside, and a patient receiving sodium nitroprusside at the maximum recommended rate (10 mcg/kg/min) would take over 16 hours to reach this total accumulated dose.
Methemoglobin levels can be measured by most clinical laboratories. The diagnosis should be suspected in patients who have received >10 mg/kg of sodium nitroprusside and who exhibit signs of impaired oxygen delivery despite adequate cardiac output and adequate arterial pO . Classically, methemoglobinemic blood is described as chocolate brown, without color change on exposure to air.
When methemoglobinemia is diagnosed, the treatment of choice is 1 to 2 mg/kg of methylene blue, administered intravenously over several minutes. In patients likely to have substantial amounts of cyanide bound to methemoglobin as cyanmethemoglobin, treatment of methemoglobinemia with methylene blue must be undertaken with extreme caution.
Thiocyanate Toxicity
As described in CLINICAL PHARMACOLOGY above, most of the cyanide produced during metabolism of sodium nitroprusside is eliminated in the form of thiocyanate. When cyanide elimination is accelerated by the co-infusion of thiosulfate, thiocyanate production is increased.
Thiocyanate is mildly neurotoxic (tinnitus, miosis, hyperreflexia) at serum levels of 1 mmol/L (60 2 mg/L). Thiocyanate toxicity is life-threatening when levels are 3 or 4 times higher (200 mg/L).
The steady-state thiocyanate level after prolonged infusions of sodium nitroprusside is increased with increased infusion rate, and the half-time of accumulation is 3 to 4 days. To keep the steady-state thiocyanate level below 1 mmol/L, a prolonged infusion of sodium nitroprusside should not be more rapid than 3 mcg/kg/min; in anuric patients, the corresponding limit is just 1 mcg/kg/min. When prolonged infusions are more rapid than these, thiocyanate levels should be measured daily.
Physiologic maneuvers (e.g., those that alter the pH of the urine) are not known to increase the elimination of thiocyanate. Thiocyanate clearance rates during dialysis, on the other hand, can approach the blood flow rate of the dialyzer.
Thiocyanate interferes with iodine uptake by the thyroid.
Abdominal pain, apprehension, diaphoresis, “dizziness,” headache, muscle twitching, nausea, palpitations, restlessness, retching, and retrosternal discomfort have been noted when the blood pressure was too rapidly reduced. These symptoms quickly disappeared when the infusion was slowed or discontinued, and they did not reappear with a continued (or resumed) slower infusion.
Other adverse reactions reported are:
Cardiovascular: Bradycardia, electrocardiographic changes, tachycardia.
Dermatologic: Rash.
Endocrine: Hypothyroidism.
Gastrointestinal: Ileus.
Hematologic: Decreased platelet aggregation.
Neurologic: Increased intracranial pressure.
Miscellaneous: Flushing, venous streaking, irritation at the infusion site.
To report SUSPECTED ADVERSE REACTIONS, contact Micro Labs USA, Inc. at 1-855-839- 8195 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
DRUG INTERACTIONS
The hypotensive effect of sodium nitroprusside is augmented by that of most other hypotensive drugs, including ganglionic blocking agents, negative inotropic agents, and inhaled anesthetics.
Read the entire FDA prescribing information for Sodium Nitropress Nitroprusside (Sodium Nitroprusside for Injection)
&Copy; Sodium Nitropress Nitroprusside Patient Information is supplied by Cerner Multum, Inc. and Sodium Nitropress Nitroprusside Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.