Indications & Dose:

Hypertensive emergencies l

• BY INTRAVENOUS INFUSION

Adult: 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 l

• BY INTRAVENOUS INFUSION

Adult: 20–400 micrograms/minute, use lower doses for patients being treated with other antihypertensives Controlled hypotension in anaesthesia during surgery l

• BY INTRAVENOUS INFUSION

Adult: Up to 1.5 micrograms/kg/minute

Acute or chronic heart failure l

• BY INTRAVENOUS INFUSION

Adult: Initially 10–15 micrograms/minute, increased every 5–10 minutes as necessary; usual dose 10–200 micrograms/minute normally for max. 3 days

OVERDOSAGE: In case of massive overdosage with signs of cyanide poisoning, stop the NITRIATE infusion immediately. Treatment of cyanide poisoning is administration of hydroxocobalamin base (30 to 60 mg/kg by IV injection) or sodium nitrite and thiosulphate

Contraindications:

Decreased cerebral perfusion, arteriovenous shunt or coarctation of the aorta (i.e., compensatory hypertension), congenital (Leber’s) optic atrophy, tobacco arnblyopia

• Hypovole, ia, Thyroid insufficiency. , ulphuryl transferase deficiency (Lang’s rhodanase).

Cautions:

Precautions:

Hepatic disease, decreased renal function, prolonged infusion, elevated intracranial pressure, anemia, hypovolemia, poor surgical risks, hypothyroidism, hyponatrernia

Interaction:

Drugs

Clonidine: Severe hypotensive reactions have been reported

Diltiazem: Reduction in the dose of nitroprusside required to produce hypotension

Guanabenz, guanfacine: Potential for severe hypotensive reactions

Warnings:

Adverse Effects:

Lactations:

Pregnancy category C

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Apprehension, dizziness, headache, increased intracranial pressure
CV: Bradycardia, ECG changes, hypotension, palpitations, retrosternal discomfort, tachycardia
GI: Abdominal pain, ileus, nausea, retching
HEMS: Decreased platelet aggregation, methemoglobinemia
METAB: Hypothyroidism
MS: Muscle twitching
SKIN: Diaphoresis, flushing, irritation at INF site,
MISC: Thiocyanate or cyanide toxicity

Patient And Carer Advice: