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nitroprusside
generic
Black Box Warnings .
Appropriate Use
after reconstitution w/ diluent must further dilute in sterile 5% dextrose before infusion
Excessive Hypotension
can cause precipitous decr. in BP; can lead to irreversible ischemic injuries or death w/o proper monitoring; monitor BP continuously during use
Cyanide Toxicity Risk
cyanide ion can reach toxic potentially lethal levels except when used briefly or at low infusion rates (<2 mcg/kg/min); usual dose rate 0.5-10 mcg/kg/min but limit infusion rate at max dose to <10min; immediately D/C if BP not controlled after 10min infusion at max rate; monitor acid-base balance and venous oxygen conc., may indicate cyanide toxicity but may provide imperfect guidance
Adult Dosing .
Dosage forms: INJ
hypertensive crisis
- [3-4 mcg/kg/min IV]
- Start: 0.3-0.5 mcg/kg/min IV, may incr. by 0.5 mcg/kg/min q5min; Max: 10 mcg/kg/min x10min
hypotension induction, controlled
- [3-4 mcg/kg/min IV]
- Start: 0.3 mcg/kg/min IV, titrate to effect; Max: 10 mcg/kg/min x10min; Info: to reduce surgical bleeding
heart failure, acute
- [3-4 mcg/kg/min IV]
- Start: 0.3 mcg/kg/min IV, titrate to effect; Max: 10 mcg/kg/min x10min
post-resuscitation stabilization (off-label)
- [0.1-5 mcg/kg/min IV]
- Start: 0.3 mcg/kg/min IV, titrate to effect; Max: 10 mcg/kg/min x10min; Info: refer to ACLS guidelines
renal dosing
- [see below]
- eGFR <30: limit mean infusion rate to <3 mcg/kg/min; anuria: limit mean infusion rate to 1 mcg/kg/min; Info: risk of thiocyanate accumulation at higher doses
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ
hypertensive crisis
- [3-4 mcg/kg/min IV]
- Start: 0.3 mcg/kg/min IV, titrate to effect; Max: 10 mcg/kg/min x10min
post-resuscitation stabilization (off-label)
- [1-8 mcg/kg/min IV]
- Start: 0.5-1 mcg/kg/min IV, titrate to effect; Max: 10 mcg/kg/min x10min; Info: refer to PALS guidelines
renal dosing
- [see below]
- eGFR <30: limit mean infusion rate to <3 mcg/kg/min; anuria: limit mean infusion rate to 1 mcg/kg/min; Info: risk of thiocyanate accumulation at higher doses
- HD/PD: not defined
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised