Blood pressure and rate control
Nitroprusside (Nipride) drip
Nipride, Nitropress, SNP
Dosing
| Start | 0.3–0.5 mcg/kg/min |
|---|---|
| Titrate | Every few minutes by arterial line |
| Maximum | 10 mcg/kg/min; stop if BP is not controlled after 10 minutes at the maximum |
| Common bags | 50 mg in 250 mL (200 mcg/mL); 100 mg in 250 mL (400 mcg/mL) |
| Dose units | mcg/kg/min |
Line and administration
- Protect from light
- Mix in D5W; dedicated line
Watch for
- Cyanide: metabolic acidosis, rising lactate, high venous O₂
- Thiocyanate in kidney failure
- Raises ICP
Nitroprusside: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Aortic Dissection and Hypertensive EmergencyAortic dissection: Beta-blocker FIRST (esmolol or labetalol), then a vasodilator (nicardipine, clevidipine or nitroprusside) if BP stays high
- Endocarditis and Valve EmergenciesValve emergencies: Papillary muscle rupture: Inferior MI, day 3–5; edema; v waves: Nitroprusside, IABP or Impella; surgery
- DKA and HHSInsulin deficiency, counter-regulation and ketones: Acetoacetate: Rises while BOHB is oxidized during treatment: Nitroprusside (urine or serum)
- Heart FailureDecompensated HF and shock: Warm-wet: Most common: IV loop diuretic; vasodilator (nitroglycerin, nitroprusside) if BP allows
- After Cardiac SurgeryHemodynamics, low output and vasoplegia: Afterload: hypertension strains suture lines and raises bleeding; use nicardipine, clevidipine or nitroprusside, or nitroglycerin when ischemia or radial spasm is the worry. After mitral repair for regurgitation the LV loses its low-pressure outlet into the atrium and tolerates afterload poorly.
- Endocrine EmergenciesPheochromocytoma crisis: Lower pressure with α-blockade or an arterial vasodilator: phentolamine 1–5 mg IV boluses or infusion, nicardipine, clevidipine or nitroprusside. Add esmolol for tachycardia only after α-blockade; labetalol alone is a poor choice because its IV β effect is about 7 times its α effect. Patients are volume-contracted, so expand volume as vessels relax. Catecholamine cardiomyo
Practice Aortic Dissection and Hypertensive Emergency questions free30 exam-style questions with rationales on the topic where nitroprusside comes up most. No account or download needed.
Other blood pressure and rate control
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.