硝普鈉
Nitroprusside Sodium
disodium (OC-6-22)pentakis(cyano-C)nitrosylferrate dihydrate
別名: Nitropress · natrii nitroprussias · sodium nitroferricyanide dihydrate · sodium nitroprussiate
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
概覽
硝普鈉 (Nitroprusside sodium) 是一種強效、超短效的混合型血管擴張劑，專門用於加護病房環境。
主要臨床重點：
- 主要適應症：處理高血壓危象、繼發於嚴重二尖瓣逆流的急性心臟衰竭，以及難治性充血性心衰竭 (CHF)。
- 血流動力學效應：透過放鬆動脈與靜脈平滑肌，迅速降低前負荷與後負荷。
- 臨床要點：由於其具有顯著的降血壓作用且半衰期極短，必須以恆速輸注 (CRI) 方式給藥，並搭配連續直接動脈血壓監測。
- 毒性風險：長時間使用（>48-72小時）或高劑量可能導致有毒代謝物（氰化物和硫氰酸鹽）累積，特別是在肝腎功能不全的病患中。
作用機制
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)
安全性與警告
禁忌症
- Compensatory hypertension (e.g., AV shunts, coarctation of the aorta, Cushing's reflex)
- Inadequate cerebral circulation
- Emergency surgery in patients near death
不良反應
- Profound hypotension
- Nausea
- Retching
- Restlessness
- Apprehension
- Muscle twitching
- Dizziness
- Infusion site irritation (avoid extravasation)
- Thiocyanate and cyanide toxicity (with prolonged use)
注意事項
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.
藥物相互作用
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.
監測
- 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)
藥物動力學
半衰期
吸收
Immediate onset of action following IV infusion. Blood pressure returns to pretreatment levels within 1-10 minutes following cessation of therapy.
分佈
Rapidly distributed in the bloodstream.
代謝
Metabolized non-enzymatically in the blood and tissues to cyanogen (cyanide radical). Cyanogen is then converted in the liver to thiocyanate.
排除
Eliminated in the urine, feces, and exhaled air.
過量
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.
可用產品
劑型
- Powder for injection
人用標示
- Nitroprusside Sodium Powder for Injection: 50 mg/vial in 2 mL and 5 mL vials (Nitropress)
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
加護病房專用藥物
- 本藥物僅限由獸醫專業人員在加護病房 (ICU) 環境中使用。
- 需要透過專用輸液幫浦進行精確的靜脈給藥，並對寵物的血壓進行每分鐘的連續監測。
- 這是一種救命藥物，用於迅速穩定患有嚴重衰竭或經歷危險高血壓危機的寵物。
- 由於藥效非常強大，獸醫團隊會密切監測您的寵物是否有低血壓跡象或藥物代謝產物引起的副作用。
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