Generic Name:

Nitroprusside Sodium

Trade Name:

Nipride

Action:

Vasodilator

Indications:

Hypertension
Afterload Reduction
Aortic Dissection
Congestive Heart Failure

Administration Guidelines:

Usual Dosage Range and Route:

10 - 800 mcg / min

Standard Concentrations:

50 mg / 250 ml

100 mg / 250 ml

250 mg / 250 ml

EW standard:

50 mg / 250 ml

Special Considerations:

- A-line is highly recommended for monitoring of blood pressure.

- If no A-line, blood pressure must be easily monitored with syphgmanometer or other non-invasive methods.

- Blood pressure parameters must be clearly defined in doctors orders.

- Blood pressure should be frequently monitored and recorded.

- PA line monitoring of cardiac output, cardiac index, PCWP, CVP, and SVR is encouraged during maintenance infusions in patients with severe heart failure and hemodynamic instability.

- Monitor for signs and symptoms of cyanide toxicity: *profound hypotension, *metabolic acidosis, *dyspnea, *headache, *loss of consciousness, *ataxia, and *vomiting. Thiocyanate level should be drawn every 24 hours during prolonged therapy.

- Nitroprusside sodium is light sensitive. IV solution must be covered with aluminum foil

- Use with caution in patients with poor renal function.

- Invasive blood pressure monitoring (e.g. a-line) should be considered when centrally administered vasoactive agents are used or when frequent changes in infusion rate are required.

Precautions and Side Effects:

- Cyanide toxicity (see above)

- Decreased PA, PCW pressures

- Tachycardia

- Hypotension