Nitroprusiato sódico
Nitroprusside Sodium
disodium (OC-6-22)pentakis(cyano-C)nitrosylferrate dihydrate
También conocido como: Nitropress · natrii nitroprussias · sodium nitroferricyanide dihydrate · sodium nitroprussiate
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Hypertensive crisis (systolic arterial BP >200 mm Hg) | Initiate dose at 1-2 micrograms/kg/minute; increase dosage incrementally every 3-5 minutes until a predetermined target BP is attained. Reduce BP 25% over 4-hour period to allow readaptation of cerebral blood vessels. | IV | CRI | Titrate to effect | 🌎 NA |
| Adjunctive treatment of heart failure (cardiogenic shock; fulminant pulmonary edema) | Initiate dose at 1-2 micrograms/kg/minute; increase dosage incrementally every 3-5 minutes. Goal is to decrease or maintain mean arterial pressure to support vital organ functions-approx. 70 mmHg. | IV | CRI | Titrate to effect | 🌎 NA |
| Adjunctive treatment of heart failure | 0.5-10 micrograms/kg/min IV at a low fluid rate (2 mL/kg/hr) using D5W or other low sodium fluid. Usually start at 2 micrograms/kg/min and increase the base concentration by 1 microgram/kg every 20-30 minutes until there is an improvement in respiratory effort and thoracic auscultation. | IV | CRI | Maintain effective dose for 48 hours | 🌎 NA |
| Catastrophic pulmonary edema | As a CRI initiated at 1 microgram/kg/min and carefully titrated to effect by increasing by 1 microgram/kg/min increments every 15 minutes as long as BP remains stable and until perfusion and pulmonary function improves (usually requires between 2-5 micrograms/kg/min with the upper limit being 8-10 micrograms/kg/min). | IV | CRI | Maintain most effective dose for 12-15 hours | 🌎 NA |
- Adjunctive treatment of heart failure (cardiogenic shock; fulminant pulmonary edema): Concurrent use of dobutamine (5-10 micrograms/kg/min) often indicated.
- Adjunctive treatment of heart failure: Monitor blood pressure; cyanide poisoning can occur if infusion lasts more than 3 days. Taper drip as enalapril is initiated.
- Catastrophic pulmonary edema: Systolic BP must remain >90 mm Hg. Wean nitroprusside over 6 hours first, then dobutamine over 6 hours.
Gatos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| Hypertensive crisis (systolic arterial BP >200 mm Hg) | Initiate dose at 0.5 micrograms/kg/minute; increase dosage incrementally every 3-5 minutes until a predetermined target BP is attained. Reduce BP 25% over 4-hour period to allow readaptation of cerebral blood vessels. | IV | CRI | Titrate to effect | 🌎 NA |
| Adjunctive treatment of heart failure (cardiogenic shock; fulminant pulmonary edema) | Initiate dose at 0.5 micrograms/kg/minute; increase dosage incrementally every 3-5 minutes. Goal to decrease or maintain mean arterial pressure to support vital organ functions-approx. 70 mmHg. | IV | CRI | Titrate to effect | 🌎 NA |
| Adjunctive treatment of heart failure | Initiate dose at 0.5 micrograms/kg/minute constant rate infusion and increase by 0.5-1 microgram/minute every 5 minutes to desired systolic pressure (90-100 mmHg). | IV | CRI | Titrate to effect | 🌎 NA |
| Catastrophic pulmonary edema | As a CRI initiated at 1 microgram/kg/min and carefully titrated to effect by increasing by 1 microgram/kg/min increments every 15 minutes as long as BP remains stable and until perfusion and pulmonary function improves (cats usually requires between 1-2 micrograms/kg/min with the upper limit being 2 micrograms/kg/min). | IV | CRI | Maintain most effective dose for 12-15 hours | 🌎 NA |
- Adjunctive treatment of heart failure (cardiogenic shock; fulminant pulmonary edema): Concurrent use of dobutamine (1-5 micrograms/kg/min) often indicated.
- Adjunctive treatment of heart failure: Cats are more sensitive to oxidative damage; keep total dosages to a minimum. Use dedicated line; never flush.
- Catastrophic pulmonary edema: Systolic BP must remain >90 mm Hg. Wean nitroprusside over 6 hours first, then dobutamine over 6 hours.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
El nitroprusiato sódico es un vasodilatador mixto de gran potencia y acción ultracorta, utilizado exclusivamente en entornos de cuidados intensivos.
Aspectos clínicos destacados:
- Indicaciones principales: Manejo de crisis hipertensivas, insuficiencia cardíaca aguda secundaria a insuficiencia mitral grave e insuficiencia cardíaca congestiva (ICC) refractaria.
- Efectos hemodinámicos: Reduce rápidamente tanto la precarga como la poscarga mediante la relajación del músculo liso arterial y venoso.
- Perla clínica: Debido a sus profundos efectos hipotensores y su vida media ultracorta, debe administrarse mediante infusión a velocidad constante (CRI) con monitorización continua de la presión arterial invasiva.
- Riesgo de toxicidad: El uso prolongado (>48-72 horas) o dosis elevadas pueden provocar la acumulación de metabolitos tóxicos (cianuro y tiocianato), especialmente en pacientes con insuficiencia renal o hepática.
Mecanismo de acción
Nitroprusside acts as a nitric oxide (NO) donor.
- Once in the bloodstream, it interacts with tissue sulfhydryl groups to release NO.
- NO activates the enzyme soluble guanylate cyclase in vascular smooth muscle cells.
- This leads to an increase in intracellular cyclic guanosine monophosphate (cGMP).
- Elevated cGMP activates protein kinase G, which reduces intracellular calcium concentrations → vascular smooth muscle relaxation.
This mechanism causes direct peripheral vasodilation of both arterioles and venules (independent of autonomic innervation), resulting in:
- Lowered blood pressure
- Significant reduction in total peripheral resistance (afterload)
- Reduced left ventricular end-diastolic pressure (preload)
- Mild decrease in cardiac output (though in severe heart failure, CO may actually increase due to afterload reduction)
- Reflex tachycardia (increase in heart rate)
Seguridad y advertencias
Contraindicaciones
- Compensatory hypertension (e.g., AV shunts, coarctation of the aorta, Cushing's reflex)
- Inadequate cerebral circulation
- Emergency surgery in patients near death
Efectos adversos
- Profound hypotension
- Nausea
- Retching
- Restlessness
- Apprehension
- Muscle twitching
- Dizziness
- Infusion site irritation (avoid extravasation)
- Thiocyanate and cyanide toxicity (with prolonged use)
Precauciones
CRITICAL WARNING: Must only be used in an ICU setting with continuous blood pressure monitoring.
- Organ Impairment: Use with extreme caution in patients with hepatic insufficiency, severe renal impairment, hyponatremia, or hypothyroidism due to increased risk of thiocyanate/cyanide toxicity.
- Surgical Use: When used for controlled hypotension during surgery, patients have less tolerance to hypovolemia, anemia, or blood loss.
- Geriatrics: Older patients may be more sensitive to hypotensive effects.
- Pregnancy: FDA Category C. Animal studies show adverse fetal effects. Use cautiously as a last resort when benefits clearly outweigh risks. Unknown if excreted in milk.
Interacciones farmacológicas
May enhance the hypotensive effects of nitroprusside.
Synergistic effects (increased cardiac output and reduced wedge pressure) may result; often used together beneficially in severe heart failure.
Patients may be more sensitive to the hypotensive effects of nitroprusside.
Monitorización
- Blood pressure (constant, direct arterial monitoring preferred)
- Acid/base balance (to detect early metabolic acidosis/cyanide toxicity)
- Electrolytes (especially Na+)
- Respiratory effort and thoracic auscultation
- Serum thiocyanate levels (if on prolonged therapy or concurrent renal dysfunction)
Farmacocinética
Vida media
Absorción
Immediate onset of action following IV infusion. Blood pressure returns to pretreatment levels within 1-10 minutes following cessation of therapy.
Distribución
Rapidly distributed in the bloodstream.
Metabolismo
Metabolized non-enzymatically in the blood and tissues to cyanogen (cyanide radical). Cyanogen is then converted in the liver to thiocyanate.
Eliminación
Eliminated in the urine, feces, and exhaled air.
Sobredosis
Acute Overdosage: Manifests as profound hypotension.
- Treatment: Reduce or stop the infusion and administer IV fluids. Blood pressure will typically recover within 1-10 minutes. Monitor BP constantly.
Toxicity (Cyanide/Thiocyanate): Excessive doses, prolonged therapy (>3 days), depleted hepatic thiosulfate, or severe hepatic/renal insufficiency may lead to cyanogen or thiocyanate toxicity.
- Signs: Metabolic acidosis (early sign of cyanogen toxicity), tolerance to therapy, delirium (thiocyanate toxicity in dogs).
- Monitoring: Monitor acid/base status. Serum thiocyanate levels >100 mcg/mL are considered toxic.
- Treatment: Hydroxocobalamin (Vitamin B12a) may prevent or treat cyanogen toxicity. Contact an animal poison control center for specific antidotal protocols if suspected.
Productos disponibles
Formulaciones
- Powder for injection
Etiquetado para humanos
- Nitroprusside Sodium Powder for Injection: 50 mg/vial in 2 mL and 5 mL vials (Nitropress)
Estado regulador
Sin datos reguladores para: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Store powder protected from light and moisture at room temperature (15-30°C). Reconstitute ONLY with 5% Dextrose in Water (D5W). Immediately protect the reconstituted solution from light using aluminum foil or an opaque cover. Stable for 24 hours after reconstitution. Discard any solution that turns blue, dark red, or green (indicates degradation and loss of potency). Do not add any other medications to the IV line running nitroprusside.
Información para el cliente
Medicamento de cuidados intensivos
- Este medicamento es de uso exclusivo por profesionales veterinarios en una unidad de cuidados intensivos (UCI).
- Requiere una administración intravenosa precisa mediante una bomba especializada y una monitorización continua, minuto a minuto, de la presión arterial de su mascota.
- Es un fármaco vital utilizado para estabilizar rápidamente a mascotas en insuficiencia cardíaca grave o que experimentan crisis de presión arterial peligrosamente alta.
- Debido a su gran potencia, el equipo veterinario vigilará estrechamente a su mascota para detectar cualquier signo de presión arterial baja o efectos secundarios derivados de los productos de degradación del medicamento.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.