After reconstitution with appropriate diluent, NITROPRESS (Sodium
Nitroprusside Injection) is not suitable for direct injection. The
reconstituted solution must be further diluted in sterile 5% dextrose
injection before infusion.
NITROPRESS can cause precipitous decreases in blood pressure (see
DOSAGE AND ADMINISTRATION).
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 pg/kg/min) infusion rates,
sodium nitroprusside gives rise to important quantities of cyanide
ion, which can reach toxic, potentially lethal levels (see WARNINGS).
The usual dose rate is 0.5-10 pg/kg/mm, 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 information should be thoroughly reviewed before administration