Saturday, April 26, 2014

Sodium Nitroprusside

Sodium nitroprusside is primarily used as a vasodilator. In this role it is abbreviated SNP, and it has tradenames like Nitropress. It acts as a drug by releasing nitric oxide; it belongs to the class of NO-releasing drugs as a result. This drug is used as a vasodilator to reduce blood pressure. Sodium nitroprusside is also used as an analytical reagent for the detection of methyl ketones, and for the detection of amines that are often found in illicit drugs.

Sodium nitroprusside is an inorganic compound with the formula Na2[Fe(CN)5NO], usually encountered as the dihydrate, Na2[Fe(CN)5NO]·2H2O. This red-colored sodium salt dissolves in water ethanol to give solutions containing the free complex dianion [Fe(CN)5NO]2−.

Sodium nitroprusside is primarily used as a vasodilator. It was first used in human medicine in 1928. By 1955, data on its safety during short-term use in patients with severe hypertension had become available. Despite this, due to difficulties in its chemical preparation, it was not until 1974 that it was finally approved by the US FDA for the treatment of severe hypertension. By 1993 its popularity had grown such that total sales in the US had totalled $2 million USD.
NITROPRESS  (Sodium Nitroprusside Injection) is not suitable for direct injection. The solution must be further diluted in sterile 5% dextrose injection before infusion.
NITROPRESS (nitroprusside sodium) can cause precipitous decreases in blood pressure . In patients not properly monitored, these decreases can lead to irreversible ischemic injuries or death. Sodium nitroprusside should be used only when available equipment and personnel allow blood pressure to be continuously monitored.
Except when used briefly or at low ( < 2 mcg/kg/min) infusion rates, sodium nitroprusside gives rise to important quantities of cyanide ion, which can reach toxic, potentially lethal levels . The usual dose rate is 0.5-10 mcg/kg/min, but infusion at the maximum dose rate should never last more than 10 minutes. If blood pressure has not been adequately controlled after 10 minutes of infusion at the maximum rate, administration of sodium nitroprusside should be terminated immediately.
Although acid-base balance and venous oxygen concentration should be monitored and may indicate cyanide toxicity, these laboratory tests provide imperfect guidance.
This package insert should be thoroughly reviewed before administration of NITROPRESS (nitroprusside sodium) .

Sodium nitroprusside has potent vasodilating effects in arterioles and venules (arterioles more than venuols, but this selectivity is much less marked than that of nitroglycerin) as a result of its breakdown to nitric oxide (NO). It is intravenously infused in cases of acute hypertensive crises. Its therapeutic effects are usually seen within a few minutes.

Nitric oxide reduces both total peripheral resistance as well as venous return, thus decreasing both preload and afterload. For this reason, it can be used in severe congestive heart failure where this combination of effects can act to increase cardiac output. In situations where cardiac output is normal, the effect is to reduce blood pressure. It is sometimes also used to induce hypotension (in order to reduce bleeding) for surgical procedures (for which it is also FDA, TGA and MHRA labelled).

This compound has also been successfully used as a treatment for: aortic valve stenosis, erythromelalgia, oesophageal varices, severe pyrexia (fever), lactic acidosis, myocardial infarction, neuroleptic malignant syndrome, pulmonary hypertension, respiratory distress syndrome in the newborn, shock, cerebral vasospasm, ergot toxicity, ventricular septal defects.

Nipress inj        -  Samarth Pharma
Niside  inj        -  Shree Ganesh Rubber & Chemicals Co
Nitroplus 50mg inj -  Neon Laboratories Ltd
Pruside inj        -  Troikaa Parenterals Pvt. Ltd.
Sonide inj         -  Gufic Limited


Dilution to proper strength for infusion: Depending on the desired concentration, the solution containing 50 mg of NITROPRESS (nitroprusside sodium) must be further diluted in 250-1000 mL of sterile 5% dextrose injection. The diluted solution should be protected from light, using the supplied opaque sleeve, aluminum foil, or other opaque material. It is not necessary to cover the infusion drip chamber or the tubing.

Verification of the chemical integrity of the product: Sodium nitroprusside solution can be inactivated by reactions with trace contaminants. The products of these reactions are often blue, green, or red, much brighter than the faint brownish color of unreacted NITROPRESS (nitroprusside sodium) . Discolored solutions, or solutions in which particulate matter is visible, should not be used. If properly protected from light, the freshly diluted solution is stable for 24 hours.

No other drugs should be administered in the same solution with sodium nitroprusside.

Avoidance of excessive hypotension: While the average effective rate in adults and children is about 3 mcg/kg/min, some patients will become dangerously hypotensive when they receive NITROPRESS at this rate. Infusion of sodium nitroprusside should therefore be started at a very low rate (0.3 mcg/kg/min), with upward titration every few minutes until the desired effect is achieved or the maximum recommended infusion rate (10 mcg/kg/min) has been reached.

Because sodium nitroprusside's hypotensive effect is very rapid in onset and in dissipation, small variations in infusion rate can lead to wide, undesirable variations in blood pressure. Sodium nitroprusside should not be infused through ordinary I.V. apparatus, regulated only by gravity and mechanical clamps. Only an infusion pump, preferably a volumetric pump, should be used.

Because sodium nitroprusside can induce essentially unlimited blood-pressure reduction, the blood pressure of a patient receiving this drug must be continuously monitored, using either a continually reinflated sphygmomanometer or (preferably) an intra-arterial pressure sensor. Special caution should be used in elderly patients, since they may be more sensitive to the hypotensive effects of the drug.

When sodium nitroprusside is used in the treatment of acute congestive heart failure, titration of the infusion rate must be guided by the results of invasive hemodynamic monitoring with simultaneous monitoring of urine output. Sodium nitroprusside can be titrated by increasing the infusion rate until:

measured cardiac output is no longer increasing,
systemic blood pressure cannot be further reduced without compromising the perfusion of vital organs, or
the maximum recommended infusion rate has been reached, whichever comes earliest. Specific hemodynamic goals must be tailored to the clinical situation, but improvements in cardiac output and left ventricular filling pressure must not be purchased at the price of undue hypotension and consequent hypoperfusion.
The table below shows the infusion rates corresponding to the recommended initial and maximal doses (0.3 mcg/kg/min and 10 mcg/kg/min, respectively) for both adults and children of various weights. Some of the listed infusion rates are so slow or so rapid as to be impractical, and these practicalities must be considered when the concentration to be used is selected. Note that when the concentration used in a given patient is changed, the tubing is still filled with a solution at the previous concentration.

Avoidance of cyanide toxicity: As described in CLINICAL PHARMACOLOGY above, when more than 500 mcg/kg of sodium nitroprusside is administered faster than 2 mcg/kg/min, cyanide is generated faster than the unaided patient can eliminate it. Administration of sodium thiosulfate has been shown to increase the rate of cyanide processing, reducing the hazard of cyanide toxicity. Although toxic reactions to sodium thiosulfate have not been reported, the co-infusion regimen has not been extensively studied, and it cannot be recommended without reservation. In one study, sodium thiosulfate appeared to potentiate the hypotensive effects of sodium nitroprusside.

Co-infusions of sodium thiosulfate have been administered at rates of 5-10 times that of sodium nitroprusside. Care must be taken to avoid the indiscriminate use of prolonged or high doses of sodium nitroprusside with sodium thiosulfate as this may result in thiocyanate toxicity and hypovolemia. Incautious administration of sodium nitroprusside must still be avoided, and all of the precautions concerning sodium nitroprusside administration must still be observed.
Sonide inj         -  Gufic Limited

Infusion Rates (mL/hour) to Achieve Initial (0.3 mcg/kg/min) and Maximal (10 mcg/kg/min) Dosing of NITROPRESS (nitroprusside sodium) 
250 ML
50 MG
200 MCG/ML
500 ML
50 MG
100 MCG/ML
1000 ML
50 MG
Consideration of methemoglobinemia and thiocyanate toxicity: Rare patients receiving more than 10 mg/kg of sodium nitroprusside will develop methemoglobinemia; other patients, especially those with impaired renal function, will predictably develop thiocyanate toxicity after prolonged, rapid infusions. In accordance with the descriptions in ADVERSE REACTIONS above, patients with suggestive findings should be tested for these toxicities.
WARNING: Do not use flexible container in series connections.


Sonide (50 Mg)
(1 Unit in Injection)
Gufic Chem Pvt Ltd
Rs. 45/Injection

Niside (50 Mg)
(1 Unit in Injection)
Shree Ganesh Pharmaceuticals
Rs. 120/Injection

Pruside (50 Mg)
(1 Unit in Injection)
Troikaa Pharmaceuticals Ltd
Rs. 140/Injection

Nitroplus (50 Mg)
(1 Unit in Injection)
Neon Laboratories Ltd
Rs. 144/Injection

Nitoside (50Mg)
(1 Unit in Injection)
Neon Laboratories Ltd
Rs. 144/Injection

Nipress (50 Mg)
(1 Unit in Injection)
Samarth Life Sciences Pvt. Ltd
Rs. 157/Injection

No comments:

Post a Comment