Nitroprusside
Nitroprusside is a potent, rapid-acting vasodilator used primarily in critical care settings to treat severe hypertension and acute heart failure. It works by releasing nitric oxide, causing smooth muscle relaxation in blood vessels. Due to its strength and need for continuous monitoring, it is administered intravenously in hospital settings under close supervision.
A rapid-acting IV vasodilator used in emergencies for severe hypertension and acute heart failure.
This medication carries a boxed (black box) warning — the strongest type of FDA warning. Review the full prescribing information before use.
Key facts at a glance
- ATC
- C02DD01
- RxNorm
- 7476
- Generic
- Nitroprusside
- Class
- atc-c02
- Brands
- Nipride
- Availability
- rx
- Pregnancy
- C
- Lactation
- caution
- Routes
- —
- Forms
- injection
- Regions
- US, EU, CN, JP
- Monitoring
- —
This page is for informational purposes only.
Do not use this information to diagnose yourself or to replace a physician's advice. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. If you believe you are experiencing a medical emergency, call your local emergency number immediately.
Dosage and administration
- Usual dose
- 500mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 250mg twice daily
- Maximum
- consult physician
- Frequency
- every 12 hours
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
- Usual dose
- 400mg daily
- Maximum
- consult physician
- Frequency
- once daily
- Instructions
- Follow physician instructions
- Duration limits
- as prescribed
- Monitoring
- standard
Overdose information
Special Populations
12 groupspregnancy
first trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks
regular fetal monitoring
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
second trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks
regular fetal monitoring and uterine blood flow assessment
Use of this medication in this population requires careful consideration of risks and benefits.
pregnancy
third trimesteravoid if possible
avoid use during pregnancy unless benefits outweigh risks
regular fetal monitoring and uterine activity monitoring
Use of this medication in this population requires careful consideration of risks and benefits.
pediatric_age
neonatesreduce dose and titrate slowly
use only in critical settings with close monitoring
continuous blood pressure monitoring and cyanide levels
Use with caution and monitor for adverse effects.
pediatric_age
children 1 12 yearsreduce initial dose to 0.3-0.5 mcg/kg/min
use only in critical settings with close monitoring
continuous blood pressure and heart rate monitoring
Use with caution and monitor for adverse effects.
geriatric
elderly 65 years and olderstart at lower end of dosing range
use with caution due to increased sensitivity and potential for orthostatic hypotension
frequent blood pressure monitoring, assess renal function
Use with caution and monitor for adverse effects.
renal_impairment
mild to moderateuse lower doses and monitor closely
monitor thiocyanate levels with prolonged use
monitor renal function and thiocyanate levels
Use with caution and monitor for adverse effects.
renal_impairment
severeavoid or use with extreme caution
avoid prolonged use, consider alternative agents
mandatory thiocyanate level monitoring
Use of this medication in this population requires careful consideration of risks and benefits.
hepatic_impairment
mild to moderateuse with caution
monitor cyanide levels closely as liver metabolizes cyanide
monitor cyanide and thiocyanate levels
Use with caution and monitor for adverse effects.
hepatic_impairment
severeavoid if possible
avoid use in severe hepatic impairment
mandatory cyanide and thiocyanate level monitoring
Use of this medication in this population requires careful consideration of risks and benefits.
lactation
breastfeedingdiscontinue breastfeeding
discontinue breastfeeding during treatment and for at least 24 hours after
no specific monitoring required
Use of this medication in this population requires careful consideration of risks and benefits.
alcohol_users
chronic alcohol useuse with caution
may have increased risk of hypotension and cyanide toxicity
monitor blood pressure closely
Use with caution and monitor for adverse effects.
Statistics and clinical data
FDA approved since
Original FDA approval year for sodium nitroprusside
Drug class
ATC classification C02DD (nitroprusside)
Common uses
Primary therapeutic applications
Mechanism of action
Pharmacodynamic properties
Treatment of hypertensive emergencies, acute decompensated heart failure, and controlled hypotension during surgery. Particularly useful when rapid reduction of blood pressure is required.
Releases nitric oxide, which activates guanylate cyclase in vascular smooth muscle, leading to increased cGMP and smooth muscle relaxation. This causes vasodilation of both arteries and veins, reducing blood pressure and cardiac workload.
Must be administered intravenously with continuous blood pressure monitoring. Can cause cyanide and thiocyanate toxicity with prolonged use. Protect solution from light during administration. Use only in critical care settings with appropriate monitoring equipment. Requires careful titration.
Contraindications
Conditions and patient states where this medication should be avoided or used with caution.
Do not use (1)
Known allergy to this medication or its components
Use caution (1)
Consult healthcare provider for benefits vs risks assessment
Official drug label
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This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.
If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.
Medically reviewed by WellAlly Editorial Team Last reviewed August 24, 2026. · Read our editorial policy