GENERIC NAME: SODIUM NITROPRUSSIDE - INJECTION (nye-troh-PRUSS-ide)
BRAND NAME(S): Nitropress
WARNING: This drug can cause very large decreases in blood pressure. Without proper monitoring, serious injury or death could result. Nitroprusside, especially in larger-than-recommended doses, might cause cyanide poisoning. Therefore, do not exceed the maximum nitroprusside IV rate (10 mcg/kg/min), especially if the patient has kidney problems. In fact, the maximum IV rate should not be continued more than 10 minutes. If blood pressure is not properly controlled after 10 minutes at the maximum IV rate, nitroprusside should be stopped. Cyanide accumulation might be avoided by monitoring for acid- base metabolic problems (metabolic acidosis), including tests for blood pH. If signs of acidosis occur, nitroprusside may be stopped. Consult the doctor or pharmacist.
USES: This medication is used for the immediate control of very high blood pressure. Nitroprusside is also used to treat certain heart problems (congestive heart failure) or to control bleeding during surgery.
HOW TO USE: This medication is diluted in liquid and given continuously into a vein (IV infusion). Dosage is based on the patient's condition and response to the drug. Maximum recommended doses should not be given for more than 10 minutes. Follow all instructions for proper mixing and dilution with the correct IV fluids. Consult the pharmacist. The diluted fluid should be protected from light by promptly wrapping it with an opaque sleeve or aluminum foil. This medication should be checked visually for particles or discoloration before use. Do not use the liquid if particles are present or if it is blue, green, red or darker than a faint brown color.
SIDE EFFECTS: Nausea, dizziness or pain/redness at the injection site may occur. If these effects persist or worsen, notify the doctor. Unlikely but report promptly: sweating, mental/mood changes, headache, stomach pain, muscle weakness, muscle spasms. Very unlikely but report promptly: trouble breathing, chest pain, fast/slow/irregular pulse, ringing in the ears, changes in skin appearance, rash, unusual bleeding, seizures. If you notice other effects not listed above, contact your doctor or pharmacist.
PRECAUTIONS: Tell the doctor the patient's medical history, including: any allergies, liver disease, kidney disease, heart disease, anemia, dehydration, breathing problems, circulation problems (e.g., aortic coarctation, coronary or carotid artery disease), stroke (as well as increased intracranial pressure), thyroid problems (hypothyroid), eye problems (tobacco amblyopia, Leber's congenital optic atrophy). This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with the doctor. It is not known whether this drug is excreted into breast milk. Because of the potential risk to the infant, breast-feeding while using this drug is not recommended. Consult the doctor before breast-feeding. Use with caution in the elderly, as they may be more sensitive to the effects of this medication (e.g., blood pressure lowering).
DRUG INTERACTIONS: Tell the doctor of all nonprescription and prescription medication the patient may use, especially of: drugs that improve sexual function (e.g., sildenafil), blood pressure medications or heart medications (e.g., beta-blockers such as propranolol or metoprolol, calcium channel blockers such as diltiazem or verapamil, ganglionic-blocking drugs such as mecamylamine), anesthesia. Do not start or stop any medicine without doctor or pharmacist approval.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.
NOTES: Laboratory and/or medical tests may be performed to monitor for side effects and response to treatment.
MISSED DOSE: If the dose is interrupted, contact the doctor immediately to re-establish dosing.
STORAGE: Store vials at room temperature between 59 and 86 degrees F (15 - 30 degrees C) away from light and moisture. Store vials in the carton until they are used. After mixing and dilution in IV fluids and when protected from light (consult the pharmacist for details), the drug is stable at room temperature for 24 hours. Discard any unused liquid.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).
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You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.