Nitroprusside

• & USAGE Sodium nitroprusside is indicated for the immediate reduction of blood pressure of adult and pediatric patients in hypertensive crises. Concomitant longer-acting antihypertensive medication should be administered so that the duration of treatment with sodium nitroprusside can be minimized.

• Sodium nitroprusside should not be used in the treatment of compensatory hypertension, where the primary hemodynamic lesion is aortic coarctation or arteriovenous shunting. Sodium nitroprusside should not be used to produce hypotension during surgery in patients with known inadequate cerebral circulation, or in moribund patients (A.S.A.contraindicated

DOSAGE & ADMINISTRATION Dilution to proper strength for infusion: Depending on the desired concentration, the solution containing 50 mg of sodium nitroprusside injection must be further diluted in 250 to 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 sodium nitroprusside injection. 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 adult and pediatric patients is about 3 mcg/kg/min, some patients will become dangerously hypotensive when they receive sodium nitroprusside injection 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.

(See also the boxed warning at the beginning of this insert.) The principal hazards of sodium nitroprusside injection administration are excessive hypotension and excessive accumulation of cyanide (see also OVERDOSAGE and DOSAGE AND ADMINISTRATION ). Excessive Hypotension: Small transient excesses in the infusion rate of sodium nitroprusside can result in excessive hypotension, sometimes to levels so low as to compromise the perfusion of vital organs. These hemodynamic changes may lead to a variety of associated symptoms; see ADVERSE REACTIONS . Nitroprusside-induced hypotension will be self-limited within 1 to 10 minutes after discontinuation of the nitroprusside infusion; during these few minutes, it may be helpful to put the patient into a head-down (Trendelenburg) position to maximize venous return. If hypotension persists more than a few minutes after discontinuation of the infusion of sodium nitroprusside injection, sodium nitroprusside injection is not the cause, and the true cause must be sought. Cyanide Toxicity: As described in CLINICAL PHARMACOLOGY above, sodium nitroprusside infusions at rates above 2 mcg/kg/min generate cyanide ion (CN – ) faster than the body can normally dispose of it. (When sodium thiosulfate is given, as described under DOSAGE AND ADMINISTRATION , the body’s capacity for CN – elimination is greatly increased.) Methemoglobin normally present in the body can buffer a certain amount of CN–, but the capacity of this system is exhausted by the CN – produced from about 500 mcg/kg of sodium nitroprusside.

The most important adverse reactions to sodium nitroprusside are the avoidable ones of excessive hypotension and cyanide toxicity, described above under WARNINGS . The adverse reactions described in this section develop less rapidly and, as it happens, less commonly. Methemoglobinemia: As described in CLINICAL PHARMACOLOGY above, sodium nitroprusside infusions can cause sequestration of hemoglobin as methemoglobin. The back-conversion process is normally rapid, and clinically significant methemoglobinemia (>10%) is seen only rarely in patients receiving sodium nitroprusside injection. Even patients congenitally incapable of back-converting methemoglobin should demonstrate 10% methemoglobinemia only after they have received about 10 mg/kg of sodium nitroprusside, and a patient receiving sodium nitroprusside at the maximum recommended rate (10 mcg/kg/min) would take over 16 hours to reach this total accumulated dose. Methemoglobin levels can be measured by most clinical laboratories. The diagnosis should be suspected in patients who have received >10 mg/kg of sodium nitroprusside and who exhibit signs of impaired oxygen delivery despite adequate cardiac output and adequate arterial pO2. Classically, methemoglobinemic blood is described as chocolate brown, without color change on exposure to air. When methemoglobinemia is diagnosed, the treatment of choice is 1 to 2 mg/kg of methylene blue, administered intravenously over several minutes.

PREGNANCY Teratogenic effects: Pregnancy Category C. There are no adequate, well-controlled studies of sodium nitroprusside injection in either laboratory animals or pregnant women. It is not known whether sodium nitroprusside injection can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Sodium nitroprusside injection should be given to a pregnant woman only if clearly needed. Nonteratogenic effects: In three studies in pregnant ewes, nitroprusside was shown to cross the placental barrier. Fetal cyanide levels were shown to be dose-related to maternal levels of nitroprusside. The metabolic transformation of sodium nitroprusside given to pregnant ewes led to fatal levels of cyanide in the fetuses. The infusion of 25 mcg/kg/min of sodium nitroprusside for one hour in pregnant ewes resulted in the death of all fetuses. Pregnant ewes infused with 1 mcg/kg/min of sodium nitroprusside for one hour delivered normal lambs. According to one investigator, a pregnant woman at 24 weeks gestation was given sodium nitroprusside to control gestational hypertension secondary to mitral valve disease. Sodium nitroprusside was infused at 3.9 mcg/kg/min for a total of 3.5 mg/kg over 15 hours prior to delivery of a 478 gram stillborn infant without any obvious anomalies. Cyanide levels in the fetal liver were less than 10 mcg/mL.

Overdosage of nitroprusside can be manifested as excessive hypotension or cyanide toxicity (see WARNINGS ) or as thiocyanate toxicity (see ADVERSE REACTIONS ). 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. Treatment of cyanide toxicity: Cyanide levels can be measured by many laboratories, and blood-gas studies that can detect venous hyperoxemia or acidosis are widely available. Acidosis may not appear until more than an hour after the appearance of dangerous cyanide levels, and laboratory tests should not be awaited. Reasonable suspicion of cyanide toxicity is adequate grounds for initiation of treatment. Treatment of cyanide toxicity consists of • discontinuing the administration of sodium nitroprusside; • providing a buffer for cyanide by using sodium nitrite to convert as much hemoglobin into methemoglobin as the patient can safely tolerate; and then • infusing sodium thiosulfate in sufficient quantity to convert the cyanide into thiocyanate. The necessary medications for this treatment are contained in commercially available Cyanide Antidote Kits.

• Mar 8, 2017NDANDA209387Exela Pharma
• Nov 7, 2017ANDAANDA209493Amneal
• Dec 8, 2017ANDAANDA209352Micro Labs
• Apr 17, 2018ANDAANDA210763Mylan Labs Ltd
• Aug 17, 2018ANDAANDA210882Somerset Theraps Llc
• Apr 10, 2019ANDAANDA210114Dr Reddys
• Nov 29, 2019ANDAANDA211016Caplin
• Aug 25, 2020ANDAANDA214199Slate Run Pharma

1. 1Renal Failure7319%
2. 2Pain6216%
3. 3Injury5916%
4. 4Anxiety5815%
5. 5Unevaluable Event5515%
6. 6Drug Ineffective5314%
7. 7Fear5314%
8. 8Toxicity To Various Agents4913%
9. 9Renal Injury4412%
10. 10Emotional Distress4311%
11. 11Anhedonia4111%
12. 12Renal Impairment3810%
13. 13Stress3810%
14. 14Hypotension338.7%
15. 15Multi-organ Failure328.4%

Recent PubMed references pinned to Nitroprusside as a MeSH major topic. Citations link to pubmed.ncbi.nlm.nih.gov.

• Effects and Mechanisms of Sodium Nitroprusside, Spermidine, and Coumarin Addition In Vitro on Epichloë sinensis.
  Phytopathology · 2026 · Luo Y, Tian P
  PMID 42101191DOI 10.1094/PHYTO-09-25-0312-R
• ConBr lectin: Evaluation of embryotoxicity in Artemia salina and neuroprotective activity against sodium nitroprusside-induced oxidative stress in Nauphoeta cinerea.
  International journal of biological macromolecules · 2026 · Dos Santos CAL, de Araujo Monterio AA, Dos Santos IJM, et al.
  PMID 42097425DOI 10.1016/j.ijbiomac.2026.152332
• Dicyanoisophorone-based fluorescent probe for detecting H(2)S and monitoring nitroprusside metabolism.
  Spectrochimica acta. Part A, Molecular and biomolecular spectroscopy · 2026 · Zhang L, Cui X, Rao Z, et al.
  PMID 42061196DOI 10.1016/j.saa.2026.127955
• Nitric oxide donor sodium nitroprusside enhances iron deficiency tolerance in M7 apple plants through coordinated regulation of Fe acquisition genes and physiological responses.
  Scientific reports · 2026 · Rafiee M, Amiri J, Naseri L, et al.
  PMID 41998072DOI 10.1038/s41598-026-46454-5
• SNP treatment enhances carbohydrate and secondary metabolite accumulation in postharvest Dendrobium officinale: Insights from Biochemical and Transcriptomic Analyses.
  Plant physiology and biochemistry : PPB · 2026 · Fan Y, Chen L, Zhao M, et al.
  PMID 41849862DOI 10.1016/j.plaphy.2026.111210
• Effect of sodium nitroprusside (SNP) on drought stress mitigation through wax accumulation in Lagenaria siceraria (Molina) Standl.: an integrated GC-MS and transcriptomic approach.
  Plant cell reports · 2026 · Liu S, Zhang X, Qi S, et al.
  PMID 41831017DOI 10.1007/s00299-026-03777-x
• Sodium Nitroprusside Potentiates Capsaicin-Activated TRPV1-mediated Relaxation of Goat Detrusor Smooth Muscle.
  Neurourology and urodynamics · 2026 · Debbarma K, Barkalita L, Deka DK, et al.
  PMID 41810593DOI 10.1002/nau.70263
• Inducing an energy management crisis to combat bacterial biofilms: The mechanism of d-proline and sodium nitroprusside.
  Water research · 2026 · Quan Q, Zhao B, An Q, et al.
  PMID 41380519DOI 10.1016/j.watres.2025.125049

The 10 most recently updated of 110 ClinicalTrials.gov registrations naming Nitroprusside as an intervention. Registration is not evidence of efficacy or safety — reference crosswalk only.

• Hot Flashes and Neurovascular Function in Women
  Recruiting · Interventional · 120 enrolled · Mayo Clinic
  NCT05193968updated 2026-06-12
• EIT Evaluation of Different Antihypertensive Agents on the Ventilation-Perfusion Ratio in Patients With Acute Respiratory Failure
  Not yet recruiting · Interventional · 12 enrolled · First Affiliated Hospital of Wannan Medical College
  NCT07603037updated 2026-05-22
• Role of Sympathetic Overactivity and Angiotensin II in PTSD and CV
  Recruiting · Phase 2 · Interventional · 134 enrolled · Emory University
  NCT02560805updated 2026-05-18
• Role of Sympathetic Vasoconstriction on Insulin-Mediated Microvascular Recruitment and Glucose Uptake in Obesity
  Active not recruiting · Phase 1 · Interventional · 36 enrolled · Vanderbilt University Medical Center
  NCT03318094updated 2026-03-02
• HeartPhone Cancer Survivors Trial 2019
  Terminated · Phase 1 · Phase 2 · Interventional · 2 enrolled · Penn State University
  NCT03953326updated 2026-02-27
• Dapagliflozin and Endothelin Receptor Antagonism in Large Vessel Vasculitis (DERAIL-LVV)
  Recruiting · Phase 2 · Interventional · 60 enrolled · University of Edinburgh
  NCT06887062updated 2026-01-14
• Sodium Nitroprusside in Early Course Schizophrenia
  Terminated · Phase 2 · Interventional · 1 enrolled · Beth Israel Deaconess Medical Center
  NCT04986072updated 2025-12-30
• The Impact of Gestational Diabetes Mellitus on Cerebral Blood Flow and Cerebrovascular Function After Pregnancy
  Recruiting · Phase 1 · Interventional · 84 enrolled · Anna Stanhewicz, PhD
  NCT06911372updated 2025-12-16
• Early Neurovascular Adaptations in Aging Women
  Recruiting · Early phase 1 · Interventional · 64 enrolled · University of Missouri-Columbia
  NCT06520982updated 2025-11-26
• Testosterone Deficiency and Endothelial Dysfunction After Spinal Cord Injury
  Recruiting · Observational · 48 enrolled · Craig Hospital
  NCT07227740updated 2025-11-21

Frequently asked questions

What is Nitroprusside used for?

According to FDA labeling, Nitroprusside carries indications including: & USAGE Sodium nitroprusside is indicated for the immediate reduction of blood pressure of adult and pediatric patients in hypertensive crises. Concomitant longer-acting antihypertensive medication should be administered so that the duration of treatment with sodium nitroprusside can be minimized.. This is a reference summary of labeled uses, not medical advice or a treatment recommendation.

What class of drug is Nitroprusside?

Nitroprusside is classified as Nitroferricyanide derivatives, Vasodilator, Vasodilation.

What are the brand names for Nitroprusside?

Nitroprusside is marketed under brand names including Nipride.

What are the contraindications for Nitroprusside?

Nitroprusside labeling lists contraindications including: Sodium nitroprusside should not be used in the treatment of compensatory hypertension, where the primary hemodynamic lesion is aortic coarctation or arteriovenous shunting. Sodium nitroprusside should not be used to produce hypotension during surgery in patients with known inadequate cerebral circulation, or in moribund patients (A.S.A.. Always consult the full prescribing information and a clinician.