Formulary
Sodium nitroprusside: Indications, Dosing, Side Effects and Interactions
Sodium nitroprusside clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Sodium nitroprusside: Indications, Dosing, Side Effects and Interactions
Sodium nitroprusside clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertensive emergencies**
- **Adult** (By Intravenous Infusion): Initially 0.5-1.5 micrograms/kg/minute, adjusted in steps of 500 nanograms/kg/minute every 5 minutes, usual dose 0.5-8 micrograms/kg/minute, use lower doses if already receiving other antihypertensives, stop if response unsatisfactory with max. dose in 10 minutes, lower initial dose of 300 nanograms/kg/minute has been used.
**Maintenance of blood pressure at 30-40% lower than pretreatment diastolic blood pressure**
- **Adult** (By Intravenous Infusion): 20-400 micrograms/minute, use lower doses for patients being treated with other antihypertensives.
**Controlled hypotension in anaesthesia during surgery**
- **Adult** (By Intravenous Infusion): Up to 1.5 micrograms/kg/minute.
**Acute or chronic heart failure**
- **Adult** (By Intravenous Infusion): Initially 10-15 micrograms/minute, increased every 5-10 minutes as necessary; usual dose 10-200 micrograms/minute normally for max. 3 days.
**Hypertensive emergencies for sodium nitroprusside**
- **Neonate** (By continuous intravenous infusion): Initially 500 nanograms/kg/minute, then increased in steps of 200 nanograms/kg/minute (max. per dose 8 micrograms/kg/minute) as required, max. 4 micrograms/kg/minute if used for longer than 24 hours.
- **Child** (By continuous intravenous infusion): Initially 500 nanograms/kg/minute, then increased in steps of 200 nanograms/kg/minute (max. per dose 8 micrograms/kg/minute) as required, max. 4 micrograms/kg/minute if used for longer than 24 hours.
Cautions
Elderly; hyponatraemia; hypothermia; hypothyroidism; ischaemic heart disease
Contraindications
Compensatory hypertension; impaired cerebral circulation; Leber's optic atrophy; severe vitamin B 12 deficiency
Side effects
Frequency not known Abdominal pain; anaemia; arrhythmias; chest discomfort; cyanide toxicity; dizziness; flushing; headache; hyperhidrosis; hypothyroidism; hypovolaemia; ileus; intracranial pressure increased; methaemoglobinaemia; muscle twitching; nausea; palpitations; rash; thiocyanate toxicity Side-effects, further information Side-effects associated with over rapid reduction in blood pressure: Headache, dizziness, nausea, retching, abdominal pain, perspiration, palpitation, anxiety, retrosternal discomfort-reduce infusion rate if any of these side-effects occur. Overdose Side-effects caused by excessive plasma concentration of the cyanide metabolite include tachycardia, sweating, hyperventilation, arrhythmias, marked metabolic acidosis (discontinue and give antidote, see cyanide in Emergency treatment of poisoning ).
Pregnancy
Avoid prolonged use-potential for accumulation of cyanide in fetus.
Breast feeding
No information available. Caution advised due to thiocyanate metabolite.
Hepatic impairment
Use with caution. Avoid in hepatic failure-cyanide or thiocyanate metabolites may accumulate.
Renal impairment
Avoid prolonged use-cyanide or thiocyanate metabolites may accumulate.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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