Download Sodium Nitroprusside - Nottingham University Hospitals NHS Trust

Paediatric Intensive Care Unit
Pharmacopoeia
Sodium Nitroprusside
Presentation:
Indications:
Dose:
Route of
administration:
Directions for
Administration:
Sterile powder for reconstitution for Infusion, 50mg vials.
• Afterload reduction
• Hypertensive crisis.
0.5 microgram/kg/minute, increasing as needed in steps of 0.2 microgram/kg/minute to
maximum 8 microgram/kg/minute (max 4 microgram/kg/minute if used for > 24 hours).
Cumulative doses over 3.5mg/kg associated with higher risk of toxicity (see notes below).
Intravenous infusion. Maximum concentration for central route (preferred) 1mg in 1mL.
Maximum concentration for peripheral administration 200micrograms/mL.
Reconstitute each 50mg vial with 2mL of glucose 5% to give 25mg/mL.
Central Administration:
Patient
Amount of
Dilute to 50ml 1 mL/hr =
Dose Range
weight
drug to add with either
to a 50 mL
syringe
3mg x
0.9% saline or
1
≤15 kg
weight (kg)
5% dextrose
microgram/kg/minute 0.2 – 8
microgram/kg/minute
1.5mg x
0.9% saline or
0.5
16-30 kg
weight (kg)
5% dextrose
microgram/kg/minute
**Patients >30kg will require a 50mg in 50mL infusion. 1mL/hr will then be equivalent to
x micrograms/kg/minute, where x = 16.6 / (patient’s weight in kg).
Peripheral Administration:
Dilute to a concentration of 200 micrograms/mL. 1mL/hr will then be equivalent to x
micrograms/kg/minute, where x = 3.3 / (patient’s weight in kg).
Cautions and
Contraindications:
Common Side
Effects:
Compatibility
(Y – site):
Additional
Comments:
Protect from light by wrapping syringe and giving sets in aluminium foil.
Use with caution in renal impairment (avoid prolonged use if GFR < 20 mL/kg/1.73m2),
hyponatraemia, hypothermia, hypothyroidism, impaired cerebral circulation.
Contraindicated in severe B12 deficiency, Leber’s optic atrophy, severe hepatic
impairment. Avoid in compensatory hypertension (e.g. coarctation, AV shunt) or leftsided obstructive lesions (e.g. aortic stenosis or HOCM).
Hypotension (monitor BP closely), tachycardia, metabolic acidosis, irritation of skin at
cannula site, CNS symptoms, nausea, retching, perspiration
Compatible
Incompatible
Adrenaline
Atracurium
Calcium chloride
Dobutamine
Dopamine
Esmolol
Furosemide
Glyceryl trinitrate
Heparin
Insulin
Labetalol
Lidocaine
Magnesium
sulphate
Midazolam
Milrinone
Morphine
Noradrenaline
Potassium chloride
(up to 40mmol/L)
Potassium acid
phosphate
Vecuronium
Acetylcysteine
Amiodarone
Continuous invasive haemodynamic monitoring required. Avoid over-rapid reduction in
blood pressure, especially in hypertensive encephalopathy: can result in water shed cerebral
infarction, blindness or death. W hen discontinuing, reduce dose slowly over 15-30 minutes
to avoid any rebound effects. If used for > 72 hours, measure thiocyanate levels, which
should be < 100 microgram/mL (1.7 mmol/L). Lactic acidosis may be the first sign of
cyanide toxicity, which also causes tachycardia, sweating, hyperventilation and
arrhythmias. If cyanide toxicity suspected, discontinue (slowly- see above) and give
antidote: contact National Poisons Information Service. Freshly prepared solution for infusion
has a faint brownish tint: discard if changes to dark brown or blue. The solution is stable for
24 hours. Nursing staff to wear gloves, goggles and apron when handling solution.
Version 3, June 2014, Review June 2016.
Checked: Andrew Wignell, PICU Pharmacist/Adam Henderson, Paediatric Pharmacist
Approved: PICU Consultants.
Paediatric Intensive Care Unit
Pharmacopoeia
References
1.
2.
3.
4.
5.
nd
Medicines for Children, 2 Edition, 2003.
BNF for Children, 2013-2014.
th
Guy’s and Thomas’ Paediatric Formulary, 9 Edition, 2012.
rd
University College Hospitals Injectable Medicines Administration Guide, 3 Edition, 2010.
Trissel LA (ed), Handbook on Injectable Drugs. [online] London: Pharmaceutical Press accessed
via www.medicinescomplete.com (accessed on 14/06/2014).
6. Medusa Injectable Medicines Guide: accessed via http://medusa.wales.nhs.uk/ (accessed on
14/06/2014).
Version 3, June 2014, Review June 2016.
Checked: Andrew Wignell, PICU Pharmacist/Adam Henderson, Paediatric Pharmacist
Approved: PICU Consultants.