Sodium nitroprusside helps lower blood pressure, In patients with normal cardiac output. It is
an emergency condition for when blood pressure is very high and can potentially lead to
certain types of heart failure, and it is used during surgeries to decrease bleeding. Sodium
nitroprusside shows immediate effect within minutes when intravenously infused, in cases of
acute hypertensive crises. venous return and total peripheral resistance is reduced by Nitric
oxide, both preload and afterload. This specialty makes it more effective in severe congestive
heart failures where its combination of actions increases cardiac output. It also treats aortic
valve stenosis, Oesophageal varices, pulmonary hypertension, myocardial infarction,
respiratory distress syndrome in newborns, shock, and ergot toxicity.
Sodium nitroprusside is sold under the brand names Nipride RTU and Nitropress amongst
First discovered in 1849, it was not used in clinical treatment till 1922. It’s proven efficacy in
treating a wide range of life threatening conditions worldwide has earned it a position on
World Health Organization's List of Essential Medicines.
Forms and Dosage:
Sodium nitroprusside is sold in the form of an injection. Normally doses of 50 mg must be
further diluted in 250-1000 mL of sterile 5% dextrose injection.
The price Sodium nitroprusside
In the USA, the consumers have to pay an retail price between $13.15 – $118.03 for 2ml
supply of this injection depending on the brand being bought. However, this medicine is
much cheaper in India, where a supply of 50ml of this medicine costs USD2.
How does Sodium nitroprusside work?
Sodium nitroprusside breaks down to nitric oxide, and has potent vasodilating effects on
arterioles and veins more than arteries. It breaks down in circulation and releases nitric oxide
by binding to oxyhaemoglobin to release cyanide, methaemoglobin and nitric oxide. nitric
oxide then activates guanylate cyclase in vascular smooth muscle leading to an increased
intracellular production of cGMP. cGMP activates protein kinase G which in turn activates
phosphatases that finally inactivate myosin light chains. Myosin light chains contract
muscles, resulting is vascular smooth muscle relaxation. This allow vessels to dilate. The
actions are same as PDE5 inhibitors such as sildenafil and tadalafil that elevate cGMP
concentration by inhibiting its degradation by PDE5.
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