Nitroprusside

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Nitroprusside Brand Names- NIPRIDE RTU | Nitropress

What is Nitroprusside

Nitroprusside is an intravenous hypotensive agent effective in the acute management of hypertensive crisis and in the management of congestive heart failure.

Nitroprusside is an extremely potent vasodilator with a rapid onset and a short duration of action.

Nitroprusside is used primarily to manage hypertensive emergencies but can also be useful when immediate reduction of preload or afterload is needed.

Other uses of the drug not currently included in the U.S. product labeling include the control of paroxysmal hypertension during surgery secondary to pheochromocytoma, treatment of peripheral vasospasm secondary to ergot alkaloid overdose, adjunctive treatment in valvular (mitral and aortic) regurgitation therapy, and reduction of afterload in patients with myocardial infarction associated with persistent chest pain.

Prolonged infusions, however, have a high potential for toxicity, limiting general use of the drug. Because of its short duration, it must be administered via IV infusion.

Although nitroprusside was discovered in 1850 and shown to exert hypotensive effects in humans as early as 1929, it was not approved by the FDA for clinical use until 1974.

Indications

  1. cardiac surgery
  2. cardiogenic shock
  3. cardiopulmonary resuscitation
  4. heart failure
  5. hypertensive emergency
  6. hypertensive urgency
  7. hypotension induction
  8. mitral regurgitation
  9. postoperative hypertension
  10. pulmonary hypertension diagnosis

For the treatment of hypertensive emergency or hypertensive urgency; for controlled hypotension induction during anesthesia; or for treatment of acute heart failure

Side Effects

  1. abdominal pain
  2. ataxia
  3. bradycardia
  4. coma
  5. confusion
  6. cyanide toxicity
  7. diaphoresis
  8. dizziness
  9. dyspnea
  10. flushing
  11. headache
  12. hyperreflexia
  13. hypotension
  14. hypothyroidism
  15. ileus
  16. increased intracranial pressure
  17. injection site reaction
  18. metabolic acidosis
  19. methemoglobinemia
  20. muscle cramps
  21. mydriasis
  22. palpitations
  23. psychosis
  24. rash
  25. restlessness
  26. seizures
  27. sinus tachycardia
  28. thiocyanate toxicity
  29. tinnitus

Monitoring Parameters

  • blood pressure
  • heart rate

Contraindications

  • anemia
  • anuria
  • aortic coarctation
  • arteriovenous shunt
  • breast-feeding
  • cerebrovascular disease
  • coronary artery disease
  • cyanide toxicity
  • geriatric
  • hepatic disease
  • hereditary optic nerve atrophy (Leber’s disease)
  • high output acute heart failure
  • hypotension
  • hypothyroidism
  • hypovolemia
  • increased intracranial pressure
  • pregnancy
  • pulmonary disease
  • renal disease
  • renal failure
  • renal impairment
  • sepsis
  • toxic amblyopia

Interactions

  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
  • Acetaminophen; Dextromethorphan; Phenylephrine
  • Acetaminophen; Dextromethorphan; Pseudoephedrine
  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Guaifenesin; Phenylephrine
  • Acetaminophen; Pseudoephedrine
  • Acrivastine; Pseudoephedrine
  • Aldesleukin, IL-2
  • Alemtuzumab
  • Aliskiren
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aliskiren; Valsartan
  • Alpha-blockers
  • Alprostadil
  • Ambrisentan
  • Amifostine
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amobarbital
  • Amphetamine
  • Amphetamine; Dextroamphetamine
  • Amyl Nitrite
  • Angiotensin II receptor antagonists
  • Angiotensin-converting enzyme inhibitors
  • Apomorphine
  • Apraclonidine
  • Aripiprazole
  • Articaine; Epinephrine
  • Asenapine
  • Avanafil
  • Azilsartan
  • Azilsartan; Chlorthalidone
  • Baclofen
  • Belladonna Alkaloids; Ergotamine; Phenobarbital
  • Benzphetamine
  • Beta-blockers
  • Bortezomib
  • Brompheniramine; Carbetapentane; Phenylephrine
  • Brompheniramine; Dextromethorphan; Phenylephrine
  • Brompheniramine; Hydrocodone; Pseudoephedrine
  • Brompheniramine; Pseudoephedrine
  • Cabergoline
  • Caffeine; Ergotamine
  • Calcium-channel blockers
  • Candesartan
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Carbetapentane; Chlorpheniramine; Phenylephrine
  • Carbetapentane; Diphenhydramine; Phenylephrine
  • Carbetapentane; Guaifenesin; Phenylephrine
  • Carbetapentane; Phenylephrine
  • Carbetapentane; Phenylephrine; Pyrilamine
  • Carbetapentane; Pseudoephedrine
  • Carbidopa; Levodopa
  • Carbidopa; Levodopa; Entacapone
  • Carbinoxamine; Dextromethorphan; Pseudoephedrine
  • Carbinoxamine; Hydrocodone; Phenylephrine
  • Carbinoxamine; Hydrocodone; Pseudoephedrine
  • Carbinoxamine; Phenylephrine
  • Carbinoxamine; Pseudoephedrine
  • Cariprazine
  • Central-acting adrenergic agents
  • Cetirizine; Pseudoephedrine
  • Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
  • Chlophedianol; Guaifenesin; Phenylephrine
  • Chloroprocaine
  • Chlorpheniramine; Dextromethorphan; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Phenylephrine
  • Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Phenylephrine
  • Chlorpheniramine; Pseudoephedrine
  • Chlorthalidone; Clonidine
  • Clonidine
  • Clozapine
  • Co-Enzyme Q10, Ubiquinone
  • Cocaine
  • Codeine; Phenylephrine; Promethazine
  • Conjugated Estrogens
  • Conjugated Estrogens; Bazedoxifene
  • Conjugated Estrogens; Medroxyprogesterone
  • Dapsone
  • Desloratadine; Pseudoephedrine
  • Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
  • Dexmedetomidine
  • Dexmethylphenidate
  • Dextroamphetamine
  • Dextromethorphan; Diphenhydramine; Phenylephrine
  • Dextromethorphan; Guaifenesin; Phenylephrine
  • Dextromethorphan; Guaifenesin; Pseudoephedrine
  • Dextromethorphan; Quinidine
  • Dienogest; Estradiol valerate
  • Diethylpropion
  • Diethylstilbestrol, DES
  • Dihydrocodeine; Guaifenesin; Pseudoephedrine
  • Dihydroergotamine
  • Diphenhydramine; Hydrocodone; Phenylephrine
  • Diphenhydramine; Phenylephrine
  • Dobutamine
  • Dopamine
  • Doxazosin
  • Drospirenone; Estradiol
  • Drospirenone; Ethinyl Estradiol
  • Drospirenone; Ethinyl Estradiol; Levomefolate
  • Duloxetine
  • Elagolix; Estradiol; Norethindrone acetate
  • Enflurane
  • Ephedrine
  • Epinephrine
  • Eplerenone
  • Epoprostenol
  • Eprosartan
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Ergoloid Mesylates
  • Ergonovine
  • Ergot alkaloids
  • Ergotamine
  • Esterified Estrogens
  • Esterified Estrogens; Methyltestosterone
  • Estradiol
  • Estradiol Cypionate; Medroxyprogesterone
  • Estradiol; Levonorgestrel
  • Estradiol; Norethindrone
  • Estradiol; Norgestimate
  • Estradiol; Progesterone
  • Estrogens
  • Estropipate
  • Ethinyl Estradiol
  • Ethinyl Estradiol; Desogestrel
  • Ethinyl Estradiol; Ethynodiol Diacetate
  • Ethinyl Estradiol; Etonogestrel
  • Ethinyl Estradiol; Levonorgestrel
  • Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
  • Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
  • Ethinyl Estradiol; Norelgestromin
  • Ethinyl Estradiol; Norethindrone
  • Ethinyl Estradiol; Norethindrone Acetate
  • Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
  • Ethinyl Estradiol; Norethindrone; Ferrous fumarate
  • Ethinyl Estradiol; Norgestimate
  • Ethinyl Estradiol; Norgestrel
  • Etomidate
  • Fexofenadine; Pseudoephedrine
  • Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
  • Fluoxetine; Olanzapine
  • Fospropofol
  • General anesthetics
  • Guaifenesin; Hydrocodone; Pseudoephedrine
  • Guaifenesin; Phenylephrine
  • Guaifenesin; Pseudoephedrine
  • Guanabenz
  • Guanfacine
  • Haloperidol
  • Halothane
  • Hydralazine; Isosorbide Dinitrate, ISDN
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Hydrocodone; Phenylephrine
  • Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
  • Hydrocodone; Pseudoephedrine
  • Ibuprofen; Pseudoephedrine
  • Iloperidone
  • Iloprost
  • Indapamide
  • Intravenous Lipid Emulsions
  • Irbesartan
  • Isocarboxazid
  • Isoflurane
  • Isoproterenol
  • Isosorbide Dinitrate, ISDN
  • Isosorbide Mononitrate
  • Ketamine
  • Levodopa
  • Lisdexamfetamine
  • Lofexidine
  • Loop diuretics
  • Loratadine; Pseudoephedrine
  • Losartan
  • Lovastatin; Niacin
  • Lurasidone
  • Mecamylamine
  • Mepivacaine; Levonordefrin
  • Mestranol; Norethindrone
  • Methamphetamine
  • Methohexital
  • Methyldopa
  • Methylergonovine
  • Methylphenidate
  • Methysergide
  • Midodrine
  • Milrinone
  • Naproxen; Pseudoephedrine
  • Nebivolol; Valsartan
  • Nesiritide, BNP
  • Niacin, Niacinamide
  • Niacin; Simvastatin
  • Nitrates
  • Nitroglycerin
  • Nonsteroidal antiinflammatory drugs
  • Norepinephrine
  • Olanzapine
  • Olmesartan
  • Oxymetazoline
  • Paliperidone
  • Pemoline
  • Pentoxifylline
  • Pergolide
  • Phendimetrazine
  • Phenelzine
  • Phenoxybenzamine
  • Phentermine
  • Phentermine; Topiramate
  • Phentolamine
  • Phenylephrine
  • Phenylephrine; Promethazine
  • Phosphodiesterase inhibitors
  • Potassium-sparing diuretics
  • Prazosin
  • Prilocaine; Epinephrine
  • Procainamide
  • Procaine
  • Propofol
  • Pseudoephedrine
  • Quinidine
  • Racepinephrine
  • Rasagiline
  • Reserpine
  • Risperidone
  • Ritodrine
  • Sacubitril; Valsartan
  • Segesterone Acetate; Ethinyl Estradiol
  • Sevoflurane
  • Sildenafil
  • Silodosin
  • Sympathomimetics
  • Tadalafil
  • Telmisartan
  • Terazosin
  • Tetracaine
  • Thiazide diuretics
  • Thiopental
  • Thiothixene
  • Tizanidine
  • Tranylcypromine
  • Trazodone
  • Treprostinil
  • Valsartan
  • Vardenafil
  • Yohimbine
  • Ziprasidone

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