TM Owner Exela Pharma Sciences
Nipride 0.5mg/mL (50mg/100mL); 0.2mg/mL Injection
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Indications & Clinical Uses
- Nipride (sodium nitroprusside) is a fast-acting blood-vessel dilator given only in hospital by intravenous infusion under continuous monitoring.
- Label used: Nipride RTU, the ready-to-use product marketed by Exela Pharma Sciences (0.2 mg/mL and 0.5 mg/mL vials, no dilution needed).
- It is approved for immediate reduction of blood pressure in hypertensive crises, for producing controlled low blood pressure during surgery to reduce bleeding, and for acute heart failure.
- It is infused through a volumetric pump, starting at 0.3 mcg/kg/min and titrated to a maximum of 10 mcg/kg/min.
- IMPORTANT: the sheet strength of 25 mg/mL (50 mg in 2 mL) is a different, concentrated sodium nitroprusside product that must be diluted in 250 to 1,000 mL of 5% dextrose before use; it must not be confused with, or substituted for, ready-to-use Nipride RTU.
Side Effects
- The side effects reported most often are low blood pressure and cyanide toxicity.
- Other reactions include thiocyanate toxicity, methemoglobinemia (reduced oxygen carrying by the blood), slow or fast heart rate, an underactive thyroid and raised pressure inside the skull.
- BOXED WARNING: (A) sodium nitroprusside can cause sudden, steep falls in blood pressure that can lead to irreversible ischemic injury or death, so blood pressure must be monitored continuously; (B) it releases cyanide, dose-related, which can be lethal, and the body's ability to buffer cyanide can be exceeded in under an hour at the maximum rate.
- Tell staff at once about dizziness, confusion, breathlessness, headache or severe weakness during the infusion.
Precautions & Warnings
- Nipride RTU must only be given by clinicians with continuous blood-pressure monitoring; the maximum rate of 10 mcg/kg/min should not be continued for more than about 10 minutes.
- It must not be used in compensatory hypertension (such as aortic coarctation or arteriovenous shunting), inadequate cerebral circulation, moribund patients, Leber's optic atrophy, tobacco amblyopia, or acute heart failure with reduced peripheral vascular resistance.
- Patients with eGFR below 30 should not exceed a mean rate of 3 mcg/kg/min, and anuric patients 1 mcg/kg/min.
- Thiocyanate and methemoglobin are monitored.
- It crosses the placenta and prolonged use may expose the baby to cyanide.
- Vials are stored at 20°C to 25°C in the carton, protected from light.
Avoid Interactions
- Never give Nipride with sildenafil, tadalafil, vardenafil or riociguat: this is contraindicated because of severe blood pressure drops.
- Other blood-pressure-lowering medicines, ganglionic blockers and inhaled anaesthetics increase its blood-pressure-lowering effect.
- Do not add or mix other drugs in the same solution or line as sodium nitroprusside.
- The label describes no medicine that reduces its effect.
- In hospital, tell your care team about all prescription, non-prescription and herbal medicines you use.
References
Frequently Asked Questions
Nipride (sodium nitroprusside) is given in hospital to lower blood pressure quickly in hypertensive crises, to control blood pressure during surgery to reduce bleeding, and to treat acute heart failure. It is a vasodilator given by intravenous infusion.
Nipride (sodium nitroprusside) is infused into a vein through a volumetric pump by hospital staff, starting at 0.3 mcg/kg/min and adjusted to your blood pressure. The ready-to-use Nipride RTU needs no dilution and nothing else may be added to the same solution.
Nipride (sodium nitroprusside) most often causes low blood pressure and cyanide toxicity; thiocyanate toxicity and methemoglobinemia can also occur. The boxed warning says blood pressure can drop suddenly, risking permanent injury or death, and cyanide can reach lethal levels. Tell staff about confusion, breathlessness or dizziness.
Do not use Nipride (sodium nitroprusside) with sildenafil, tadalafil, vardenafil or riociguat; the label contraindicates them. Other blood-pressure medicines and inhaled anaesthetics add to its effect. Nothing else may be mixed into the same infusion solution.
During a Nipride (sodium nitroprusside) infusion your blood pressure is monitored continuously. Staff also watch for signs of cyanide build-up, and may check thiocyanate and methemoglobin levels. Kidney disease lowers the maximum allowed infusion rate.
No. Sodium nitroprusside 25 mg/mL (50 mg in 2 mL) is a concentrate that must be diluted in 250 to 1,000 mL of 5% dextrose. Nipride RTU (0.2 or 0.5 mg/mL) is ready to use. Do not substitute one for the other without pharmacy confirmation.
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