SODIUMNITROPRUSSIDE

Indications & Dose:

Hypertensive emergenciesBY INTRAVENOUS INFUSIONAdult: Initially 0.5–1.5 micrograms/kg/minute,adjusted in steps of 500nanograms/kg/minuteevery 5 minutes, usual dose 0.5–8 micrograms/kg/minute, use lower doses if already receivingother  antihypertensives,  stop  if  responseunsatisfactory with max. dose in 10 minutes, lowerinitial dose of 300 nanograms/kg/minute has beenusedMaintenance of blood pressure at 30–40% lowerthan pretreatment diastolic blood pressurBY INTRAVENOUS INFUSIONAdult: 20–400 micrograms/minute, use lowerdoses for patients being treated with otherantihypertensives Controlled hypotension inanaesthesia during surgeryBY INTRAVENOUS INFUSIONAdult: Up to 1.5 micrograms/kg/minuteAcute or chronic heart failureBY INTRAVENOUS INFUSION Adult: Initially 10–15micrograms/minute,increasedevery 5–10 minutes as necessary; usual dose10–200 micrograms/minute normally for max.3daysOVERDOSAGE: In case of massive overdosagewith signs of cyanide poisoning, stop the NITRIATEinfusion immediately. Treatment ofcyanidepoisoning is administration of hydroxocobalaminbase (30 to 60 mg/kg by IV injection) or sodium nitriteand thiosulphate.

Contraindications:

Decreased cerebralperfusion, arteriovenous shunt or coarctation of theaorta (i.e., compensatory hypertension), congenital(Leber’s) optic atrophy, tobacco arnblyopia •Hypovole, ia, Thyroid insufficiency. , ulphuryltransferase deficiency (Lang’s rhodanase).

Side Effects:

Cautions:

Precautions:

Hepatic disease, decreased renalfunction, prolonged infusion, elevated intracranialpressure, anemia, hypovolemia, poor surgical risks,hypothyroidism, hyponatrernia

Interaction:

Drugs Clonidine: Severe hypotensive reactions have beenreported Diltiazem: Reduction in the dose of nitroprussiderequired to produce hypotension

Guanabenz, guanfacine: Potential for severe hypotensive reactions

Warnings:

Adverse Effects:

Lactations:

Pregnancy category C

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS:  Apprehension,  dizziness,  headache,increased intracranial pressure CV: Bradycardia, ECG changes, hypotension,palpitations, retrosternal discomfort, tachycardiaGI: Abdominal pain, ileus, nausea, retchingHEMS:Decreased platelet aggregation,methemoglobinemia METAB: Hypothyroidism MS: Muscle twitching SKIN: Diaphoresis, flushing, irritation at INF site,MISC: Thiocyanate or cyanide toxicity

Patient And Carer Advice: