니트로프루시드 나트륨
Nitroprusside Sodium
disodium (OC-6-22)pentakis(cyano-C)nitrosylferrate dihydrate
다른 이름: Nitropress · natrii nitroprussias · sodium nitroferricyanide dihydrate · sodium nitroprussiate
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
고양이
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
니트로프루시드 나트륨(Nitroprusside sodium)은 중환자실 환경에서만 전적으로 사용되는 매우 강력하고 초단기 작용을 하는 혼합형 혈관확장제입니다.
주요 임상 요점:
- 주요 적응증: 고혈압 위기, 중증 승모판 역류에 속발하는 급성 심부전 및 불응성 울혈성 심부전(CHF)의 관리.
- 혈역학적 효과: 동맥 및 정맥 평활근을 이완시켜 전부하와 후부하를 빠르게 감소시킵니다.
- 임상 팁: 심각한 저혈압 효과와 매우 짧은 반감기 때문에 반드시 지속적인 직접 동맥 혈압 모니터링과 함께 지속적 정맥 주입(CRI)으로 투여해야 합니다.
- 독성 위험: 장기간 사용(>48-72시간)하거나 고용량을 투여하면, 특히 신장이나 간 기능이 손상된 환자에서 독성 대사산물(시안화물 및 티오시안산염)이 축적될 수 있습니다.
작용 기전
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)
안전성·주의사항
금기사항
- Compensatory hypertension (e.g., AV shunts, coarctation of the aorta, Cushing's reflex)
- Inadequate cerebral circulation
- Emergency surgery in patients near death
부작용
- Profound hypotension
- Nausea
- Retching
- Restlessness
- Apprehension
- Muscle twitching
- Dizziness
- Infusion site irritation (avoid extravasation)
- Thiocyanate and cyanide toxicity (with prolonged use)
주의
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.
약물 상호작용
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.
모니터링
- 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)
약동학
반감기
흡수
Immediate onset of action following IV infusion. Blood pressure returns to pretreatment levels within 1-10 minutes following cessation of therapy.
분포
Rapidly distributed in the bloodstream.
대사
Metabolized non-enzymatically in the blood and tissues to cyanogen (cyanide radical). Cyanogen is then converted in the liver to thiocyanate.
배설
Eliminated in the urine, feces, and exhaled air.
과다투여
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.
제품
제형
- Powder for injection
인용의약품
- Nitroprusside Sodium Powder for Injection: 50 mg/vial in 2 mL and 5 mL vials (Nitropress)
규제 현황
규제 데이터 없음: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
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.
보호자 정보
중환자실 전용 약물
- 이 약물은 중환자실(ICU) 환경에서 수의학 전문가에 의해서만 엄격하게 사용되어야 합니다.
- 특수 주입 펌프를 통한 정밀한 정맥 투여와 반려동물의 혈압에 대한 분 단위의 지속적인 모니터링이 필요합니다.
- 중증 심부전이나 위험할 정도로 높은 고혈압 위기를 겪고 있는 반려동물을 빠르게 안정시키기 위해 사용되는 생명 구조 약물입니다.
- 약효가 매우 강력하기 때문에 수의료진은 반려동물에게 저혈압 징후나 약물 분해 산물로 인한 부작용이 나타나지 않는지 면밀히 모니터링할 것입니다.
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