NITROPRESS ® (Sodium Nitroprusside Injection) is not suitable for direct injection. The solution must be further diluted in sterile 5% dextrose injection before infusion.
NITROPRESS can cause precipitous decreases in blood pressure (see DOSAGE AND ADMINISTRATION). In patients not properly monitored, these decreases can lead to irreversible ischemic injuries or death. Sodium nitroprusside should be used only when available equipment and personnel allow blood pressure to be continuously monitored.
Except when used briefly or at low (< 2 mcg/kg/min) infusion rates, sodium nitroprusside gives rise to important quantities of cyanide ion, which can reach toxic, potentially lethal levels (see WARNINGS). The usual dose rate is 0.5-10 mcg/kg/min, but infusion at the maximum dose rate should never last more than 10 minutes. If blood pressure has not been adequately controlled after 10 minutes of infusion at the maximum rate, administration of sodium nitroprusside should be terminated immediately.
Although acid-base balance and venous oxygen concentration should be monitored and may indicate cyanide toxicity, these laboratory tests provide imperfect guidance.
This package insert should be thoroughly reviewed before administration of NITROPRESS.
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NEWS HIGHLIGHTSMedia Articles Related to Nitropress (Nitroprusside Anion)
Orthostatic Hypotension
Source: MedicineNet Addison Disease Specialty [2009.06.11]
Title: Orthostatic Hypotension
Category: Diseases and Conditions
Created: 6/11/2009
Last Editorial Review: 6/11/2009
Low Blood Pressure (Hypotension) Photo Slideshow
Source: MedicineNet Addison Disease Specialty [2008.07.30]
Title: Low Blood Pressure (Hypotension) Photo Slideshow
Category: Slideshows
Created: 7/29/2008
Last Editorial Review: 7/30/2008
Published Studies Related to Nitropress (Nitroprusside Anion)
Randomized evaluation of intracoronary nitroprusside vs. adenosine after thrombus aspiration during primary percutaneous coronary intervention for the prevention of no-reflow in acute myocardial infarction: the REOPEN-AMI study protocol. [2009.07]
CONCLUSIONS: REOPEN-AMI will provide important data on the efficacy and safety of intracoronary nitroprusside and adenosine as an adjunctive treatment to percutaneous coronary intervention after thrombus aspiration for patients with acute myocardial infarction.
The ECLIPSE trials: comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients. [2008.10]
BACKGROUND: Acute hypertension during cardiac surgery can be difficult to manage and may adversely affect patient outcomes. Clevidipine is a novel, rapidly acting dihydropyridine L-type calcium channel blocker with an ultrashort half-life that decreases arterial blood pressure (BP). The Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events trial (ECLIPSE) was performed to compare the safety and efficacy of clevidipine (CLV) with nitroglycerin (NTG), sodium nitroprusside (SNP), and nicardipine (NIC) in the treatment of perioperative acute hypertension in patients undergoing cardiac surgery... CONCLUSIONS: CLV is a safe and effective treatment for acute hypertension in patients undergoing cardiac surgery.
Influence of controlled hypotension using esmolol and sodium nitroprusside on natriuretic peptides in patients undergoing endonasal sinus surgery. [2007.06]
BACKGROUND AND OBJECTIVE: Atrial and brain natriuretic peptide, synthesized by cardiac myocytes, are mediators secreted secondary to cardiac volume expansion and increased filling pressure. The study was designed to assess serum concentration of atrial and brain natriuretic peptide in patients undergoing endonasal sinus surgery receiving controlled hypotension... CONCLUSIONS: Controlled hypotension decreases the release of natriuretic peptides in cardiovascular healthy patients. This effect may be contributed to by changes in cardiac filling pressure due to lower systemic resistance and diminished perfusion pressure.
[Controlled hypotension for tympanoplasty: comparison between remifentanil and combination of alfentanil and sodium nitroprusside] [2007]
OBJECTIVES: We compared the efficacy of remifentanil and the combination of alfentanil and sodium nitroprusside on controlled hypotension and bleeding at surgical site... CONCLUSION: Our results suggest that remifentanil is effective in obtaining controlled hypotension without an additional potent hypotensive agent and provides appropriate surgical conditions by reducing the amount of bleeding.
Intracoronary nitroprusside for the prevention of the no-reflow phenomenon after primary percutaneous coronary intervention in acute myocardial infarction. A randomized, double-blind, placebo-controlled clinical trial. [2006.11]
BACKGROUND: The aim of this study was to test whether nitroprusside (NTP) injected intracoronary immediately before primary angioplasty for acute ST-elevation acute myocardial infarction (STEMI) prevents no-reflow and improves vessel flow and myocardial perfusion... CONCLUSIONS: In patients with STEMI, selective intracoronary administration of a fixed dose of NTP failed to improve coronary flow and myocardial tissue reperfusion but improved clinical outcomes at 6 months.
Clinical Trials Related to Nitropress (Nitroprusside Anion)
Sodium Nitroprusside for Blood Pressure Reduction in the ICU [Recruiting]
Nitroprusside is used commonly in the Intensive Care Unit for long periods of time in order
to reduce blood pressure. It is not known if the body compensates over time to the blood
pressure lowering, and if when the nitroprusside is stopped the blood pressure goes up at a
faster rate and is higher than it was at the start of the treatment. This study will answer
these questions.
Dose-Response Study of Sodium Nitroprusside in Children Requiring Controlled Hypotension in the Operating Room [Recruiting]
Sodium nitroprusside (SNP) has been approved for control of blood pressure in adults, yet
there are no controlled studies in children. The purpose of this study is to determine the
efficacy and safety of sodium nitroprusside in children who will be having surgery, and who
require blood pressure lowering in order to decrease the amount of blood loss during their
surgery.
Clinical Study Investigating the Effect of Sodium Nitroprusside Infusion on Thyroidal Function [Recruiting]
Whether use of SNP during cardiac surgery has any effect on thyroid function has not yet
been investigated in humans. The aim of this study was to investigate the effects of SNP
administration during the rewarming period of cardiac operations on circulating levels of
thyroid hormones.
Nitroprusside for Prevention of no-Reflow in Primary Angioplasty [Terminated]
In patients admitted with acute myocardial infarction, there is a total occlusion of a
coronary artery. Even after emergency catheterization and angioplasty, in some patients, the
resumed blood flow is suboptimal and impacts on heart function. The study is aimed at
examining whether nitroprusside, an anti-hypertension medication, given directly into the
coronary artery, can improve the blood flow after the removal of the obstruction that caused
the infarction.
THE REOPEN-AMI STUDY - Intracoronary Nitroprusside Versus Adenosine in Acute Myocardial Infarction [Not yet recruiting]
The occurrence of no-reflow phenomenon after recanalization of the infarct related artery in
acute myocardial infarction is described in up to 40% of cases. This event is associated
with a worse prognosis at follow up and an unfavourable left ventricular remodelling . Two
main pathogenetic mechanisms cause no-reflow: distal embolization and ischemia-reperfusion
injury.
Due to the multifactorial pathogenesis of no-reflow during acute MI a combined mechanic and
pharmacologic approach is believed to offer a better solution for achieving optimal
microvascular reperfusion. Thus, in this randomized study we will assess the effect of
nitroprusside or adenosine in adjunct to current best therapy (thrombus aspiration and
IIb-IIIa antagonists) for ST elevation MI using ST segment resolution on standard 12 leads
ECG as primary endpoint of myocardial reperfusion.
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