niprid

Uses

niprid is a direct acting vasodilator used to treat hypertension, to induce controlled hypotension to reduce postoperative bleeding, and to manage acute heart failure.

For immediate reduction of blood pressure of patients in hypertensive crises, reduce bleeding during surgery, and for the treatment of acute congestive heart failure

niprid is also used to associated treatment for these conditions: Bleeding, Congestive Heart Failure (CHF), Hypertensive crisis

How niprid works

One molecule of sodium nitroprusside is metabolized by combination with hemoglobin to produce one molecule of cyanmethemoglobin and four CN- ions; methemoglobin, obtained from hemoglobin, can sequester cyanide as cyanmethemoglobin; thiosulfate reacts with cyanide to produce thiocyanate; thiocyanate is eliminated in the urine; cyanide not otherwise removed binds to cytochromes. Cyanide ion is normally found in serum; it is derived from dietary substrates and from tobacco smoke. Cyanide binds avidly (but reversibly) to ferric ion (Fe+++), most body stores of which are found in erythrocyte methemoglobin (metHgb) and in mitochondrial cytochromes. When CN is infused or generated within the bloodstream, essentially all of it is bound to methemoglobin until intraerythrocytic methemoglobin has been saturated.

Sodium nitroprusside is further broken down in the circulation to release nitric oxide (NO), which activates guanylate cyclase in the vascular smooth muscle. This leads to increased production of intracellular cGMP, which stimulates calcium ion movement from the cytoplasm to the endoplasmic reticulum, reducing the level of available calcium ions that can bind to calmodulin. This ultimately results in vascular smooth muscle relaxation and vessel dilation.

Toxicity

Overdosage of nitroprusside can be manifested as excessive hypotension or cyanide toxicity or as thiocyanate toxicity. The acute intravenous mean lethal doses (LD₅₀) of nitroprusside in rabbits, dogs, mice, and rats are 2.8, 5.0, 8.4, and 11.2 mg/kg, respectively.

Food Interaction

niprid Drug Interaction

Moderate: meperidine, haloperidol, dexmedetomidineMinor: diltiazemUnknown: aspirin, RHO Immunoglobulin , mycophenolate mofetil, sulfamethoxazole / trimethoprim, warfarin, apixaban, gentamicin, heparin, furosemide, levofloxacin, norepinephrine, enoxaparin, insulin isophane, acetaminophen, clopidogrel, midazolam

niprid Disease Interaction

Major: cerebral vascular insufficiency, compensatory hypertension, congenital optic atrophy, sepsisModerate: anemia, hepatic impairment, intracranial hypertension

Half Life

Approximately 2 minutes

Elimination Route

One molecule of sodium nitroprusside is metabolized by combination with hemoglobin to produce one molecule of cyanmethemoglobin and four CN¯ ions, thiosulfate reacts with cyanide to produce thiocyanate, thiocyanate is eliminated in the urine.

Innovators Monograph

You find simplified version here niprid