sodium nitroprusside

CLINICAL USE

Hypertensive crisis Heart failure Controlled hypotension in surgery

DOSE IN NORMAL RENAL FUNCTION

0.3–8 micrograms/kg/minute Maintenance of blood pressure: 20–400 mcg/minuteHeart failure: 10–200 mcg/minute Controlled blood pressure in surgery: maximum 1.5 mcg/kg/minute

PHARMACOKINETICS

Molecular weight :297.9

%Protein binding :0

%Excreted unchanged in urine :

<10 :

Volume of distribution (L/kg) :0.2

half-life – normal/ESRD (hrs) :2–10 minutes/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function. Avoid prolonged use

<10 : Dose as in normal renal function. Avoid prolonged use

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Dialysed. Dose as in GFR <10 mL/min

HD :Dialysed. Dose as in GFR <10 mL/min

HDF/high flux :Dialysed. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

ADMINISTRATION

Reconstition

2–3 mL glucose 5%

Route

Rate of Administration

10–400 micrograms/minute, adjusted according to response

Comments

Dilute 50 mg in 250–1000 mL glucose 5% to give a concentration of 50–200 mcg/mLMinimum volume is 1 mg/mL via central line. (UK Critical Care Group Minimum Infusion Volumes for fluid restricted critically ill patients, 3rd Edition, 2006)Wrap syringes and lines in foil to protect from light

OTHER INFORMATION

Sodium nitroprusside is rapidly metabolised to cyanogen which is converted to thiocyanateAvoid prolonged use in renal impairment because accumulation of thiocyanate (which is dialysable) may cause seizures or a comaMonitor thiocyanate and cyanide levels Do not stop infusion abruptly – tail off over 10–30 minutessodium nitroprusside.

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