Sodium nitroprusside - the role in rapid reduction of blood pressure. Current drug analysis

Abstract

Sodium nitroprusside (SNP) is a potent, effective and readily reversible direct vasodilating agent. It is broken down by hemoglobin into cyanide, which in part detoxified by liver and kidney to thiocyanate. Some cyanide, especially in nitroprusside, resistant individuals who need large amount of the drug, appears to remain free to cause cyanide poisoning.
SNP appears useful for induction of hipotension during surgery and for treatment of hipertensive emergencies from all causes, although continuance for more than a few days is probably dangerous. It is hoped that future studies will establish the maximum dose of nitroprusside that can safely be metabolized in a 24 hour period and may indicate that cofactors of rhodanase such as thiosulfate or cobalamins such as hydroxocobalamin can be administered with nitroprusside to prevent cyanide poisoning.
Despite its toxicity, SNP is popular because it is often the most effective drug in some difficult circumstances.