Names and pronunciation
(nye-troe-pruss′ide) Nitropress, Nipride
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Drug reference
(nye-troe-pruss′ide) Nitropress, Nipride
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Func. class.: Antihypertensive, vasodilator
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ACTION: Directly relaxes arteriolar, venous smooth muscle, thereby resulting in reduction in cardiac preload and afterload
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USES: Hypertensive crisis/urgency/ induction; to decrease bleeding by creating hypotension during surgery; acute HF
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CONTRAINDICATIONS: Hyper- sensitivity, hypertension (compensatory) due to aortic coarctation or AV shunting, acute HF associated with reduced periph- eral vascular resistance, toxic amblyopia, hypothyroidism Precautions: Anemia, increased intracranial pressure, pregnancy, breastfeeding, children, geriatric patients, hypovolemia, electrolyte imbalances, renal/hepatic disease, hypothyroidism
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Black Box Warning: Hypotension, cya- nide toxicity Black Box Warning: Hypotension: B/P by direct means if possible; check ECG continuously; pulse, jugular venous dis- tention; PCWP; rebound hypertension may occur after nitroprusside is discon- tinued, give only with emergency equip- ment nearby, rapid decrease in B/P may occur; check weight, I&O daily Black Box Warning: Thiocyanate, lac- tate, cyanide toxicity: obtain levels daily if infusion >3 mcg/kg/min; thiocyanate toxicity occurs at plasma levels of 50-100 mcg/mL; thiocyanate toxicity includes confusion, weakness, seizures, hyperre- flexia, psychosis, tinnitus, coma • Nausea, vomiting, diarrhea • Edema in feet, legs daily; skin turgor, dryness of mucous membranes for hy- dration status • Crackles, dyspnea, orthopnea q30min • For decrease in bicarbonate, PaCO2, blood pH, acidosis • Pregnancy/breastfeeding: prolonged use may result in death of the fetus (cya- nide toxicity); do not breastfeed
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SIDE EFFECTS CNS: Dizziness, headache, agitation, twitching, decreased reflexes, restlessness CV: Bradycardia, ECG changes, tachy- cardia, hypotension GI: Nausea, vomiting, abdominal pain INTEG: Pain, irritation at inj site, sweating MISC: Cyanide, thiocyanate toxicity, flush ing, hypothyroidism
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INTERACTIONS Increase: severe hypotension—ganglionic blockers, volatile liquid anesthetics, halo- thane, enflurane, circulatory depressants Drug/Herb Increase: antihypertensive effect— hawthorn
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DOSAGE AND ROUTES • Adult/child: IV INFUSION 0.25-10 mcg/kg/min; max 10 mcg/kg/min × 10 min Renal dose • Adult: IV INFUSION CCr <60 mL/min, maintain doses <3 mcg/kg/min to reduce thiocyanate accumulation
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Available forms: Inj 50 mg/2 mL
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Administer: • Antidote is sodium thiosulfate Continuous IV INFUSION route • Black Box Warning: Reconstitute 50 mg/2-3 mL of D5W, further dilute in 250, 500, or 1000 mL of D5W to 200, 100, 50 mcg/mL, respectively; use infusion pump only; wrap bottle with aluminum foil to protect from light; observe for color change in infusion; discard if highly dis- colored (blue, green, dark red); titrate to patient response • Black Box Warning: Stop infusion if B/P is not lowered sufficiently within 10 min N • Black Box Warning: Monitor continu- ously • Do not exceed max dose as cyanide may accumulate compatibilities: Alfentanil, Y-site alprostadil, amikacin, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, anid- ulafungin, argatroban, atenolol, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluco- nate, CARBOplatin, cefamandole, ceFAZo- lin, cefmetazole, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, chlorampheni- col, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomy- cin, DAPTOmycin, dexamethasone, digoxin, diltiazem, DOCEtaxel, DOPa- mine, doxacurium, DOXOrubicin, doxy- cycline, enalaprilat, ePHEDrine, EPI- NEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etopo- side, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, furosemide, ganciclovir, gati- floxacin, gemcitabine, gemtuzumab, gen- tamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmor- phone, IDArubicin, ifosfamide, inamri- none, indomethacin, insulin (regular), isoproterenol, ketorolac, labetalol, lido- caine, linezolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, metaraminol, methicillin, methoxamine, methyldopate, methyl- PREDNISolone, metoclopramide, meto- prolol, metroNIDAZOLE, mezlocillin, micafungin, miconazole, midazolam, milrinone, minocycline, morphine, mox- alactam, multiple vitamins injection, naf- cillin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondanse- tron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, penicillin G potassium/sodium, pentamidine, PENTo- barbital, PHENobarbital, phentolamine, phenylephrine, phytonadione, piperacil- lin, piperacillin-tazobactam, polymyxin B, potassium chloride/phosphates, pro- cainamide, propofol, propranolol, protamine, pyridoxine, ranitidine, rito- drine, rocuronium, sodium acetate/ bicarbonate, succinylcholine, SUFent- anil, tacrolimus, teniposide, theophyl- line, thiamine, ticarcillin, ticarcillin-cla- vulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, uro- kinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, zoledronic acid
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Assess: • Electrolytes: potassium, sodium, chloride, CO2, CBC, serum glucose, serum methemoglobin if pulmonary O2 levels are decreased; use IV 1-2 mg/kg methylene blue given over several min for methemoglobinemia, ABGs • Renal studies: catecholamines, BUN, creatinine • Hepatic studies: AST, ALT, alk phos
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Evaluate: • Therapeutic response: decreased B/P, decreasing symptoms of cardiogenic shock or cardiac pump failure
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report headache, dizziness, loss of hearing, blurred vision, dyspnea, faint- ness, pain at IV site • About the reason for giving product and expected results
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PHARMACOKINETICS IV: Onset 1-2 min, duration 1-10 min, half-life 2 min; metabolized in liver, excreted in urine
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• Adult/child: IV INFUSION 0.25-10 mcg/kg/min; max 10 mcg/kg/min × 10 min Renal dose
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