nye-troe-PRUSS-ide
High Alert
Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Half-Life: 2 min.
Contraindicated in:
Use Cautiously in:
CV: dyspnea, HYPOTENSION, palpitations
EENT: blurred vision, tinnitus
F and E: acidosis
GI: abdominal pain, nausea, vomiting
Local: phlebitis
Neuro: dizziness, headache, restlessness
Misc: CYANIDE TOXICITY, thiocyanate toxicity
Drug-drug:
Monitor BP, HR, and ECG frequently throughout therapy; continuous monitoring is preferred. Monitor for rebound hypertension following discontinuation of nitroprusside.
Lab Test Considerations:
May ↑ cyanide and thiocyanate concentrations.
Toxicity and Overdose:
Cyanide toxicity may manifest as lactic acidosis, hypoxemia, tachycardia, altered consciousness, seizures, and characteristic breath odor similar to almonds. Acute treatment of cyanide toxicity includes 4–6 mg/kg of sodium nitrite (as a 3% solution) over 2–4 min. This acts as a buffer for cyanide by converting 10% of hemoglobin to methemoglobin. If administration of sodium nitrite is delayed, inhalation of crushed ampule of amyl nitrite for 15–30 sec of every minute should be started until sodium nitrite is running. Following completion of sodium nitrite infusion, administer sodium thiosulfate 150–200 mcg/kg (available as 25% and 50% solutions). This will convert cyanide to thiocyanate, which may then be eliminated. If required, entire regimen may be repeated in 2 hr at 50% of the initial doses.
If infusion of 10 mcg/kg/min for 10 min does not produce adequate ↓ in BP, manufacturer recommends nitroprusside be discontinued.
IV Administration: