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NIPRIDE RTU
Overview
What is NIPRIDE RTU?
Sodium nitroprusside is disodium pentacyanonitrosylferrate(2-) dihydrate, a hypotensive agent whose structural formula is
Sodium Nitroprusside has molecular formula Na[Fe(CN)NO] • 2HO and molecular weight of 297.95. Dry sodium nitroprusside is a reddish-brown powder, soluble in water.
Sodium nitroprusside solution is rapidly degraded by trace contaminants, often with resulting color changes
[see Dosage and Administration ()]
.
NIPRIDE RTU is supplied as a sterile, unpreserved, colorless to red-brown solution packaged in a single-use 100-mL vial. Each 100 mL of solution in vial contains 50 mg of sodium nitroprusside (0.5 mg/mL), 900 mg of sodium chloride, USP (9 mg/mL), in sterile water for injection, USP.
NIPRIDE RTU is also supplied as a sterile, unpreserved, colorless to red-brown solution packaged in a single-use 50-mL vial. Each 50 mL of solution in vial contains 10 mg of sodium nitroprusside (0.2 mg/mL), 450 mg of sodium chloride, USP (9 mg/mL), in sterile water for injection, USP.
What does NIPRIDE RTU look like?
What are the available doses of NIPRIDE RTU?
Injection: 50 mg of sodium nitroprusside in 100 mL of 0.9% sodium chloride (0.5 mg/mL) in 100 mL single-use vials and 10 mg of sodium nitroprusside in 50 mL of 0.9% sodium chloride (0.2 mg/mL) in 50 mL single-us vials ().
What should I talk to my health care provider before I take NIPRIDE RTU?
How should I use NIPRIDE RTU?
Sodium nitroprusside is indicated for the immediate reduction of blood pressure of adult and pediatric patients in hypertensive crises.
Inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit. Sodium nitroprusside should be a clear colorless to red/brown color; do not use if solution is blue, green, or bright red.
What interacts with NIPRIDE RTU?
Sorry No Records found
What are the warnings of NIPRIDE RTU?
Sorry No Records found
What are the precautions of NIPRIDE RTU?
Sorry No Records found
What are the side effects of NIPRIDE RTU?
Sorry No records found
What should I look out for while using NIPRIDE RTU?
Diseases with compensatory hypertension (e.g. coarctation of the aorta, arteriovenous shunting) ().
Inadequate cerebral circulation or moribund patients (A.S.A. Class 5E) coming to emergency surgery ().
Congenital (Leber’s) optic atrophy or tobacco amblyopia ().
Acute heart failure with reduced peripheral vascular resistance ().
Concomitant use with sildenafil, tadalafil, vardenifil, or riociguat ()
(A) EXCESSIVE HYPOTENSION:
Sodium Nitroprusside can cause precipitous decreases in blood pressure which can lead to irreversible ischemic injuries or death. Use only with continuous blood pressure monitoring
(B) CYANIDE TOXICITY:
Sodium nitroprusside metabolism produces dose-related cyanide, which can be lethal. A patient’s ability to buffer cyanide will be exceeded in less than one hour at the maximum dose rate (10 mcg/kg/min); limit infusions at the maximum rate to as short a duration as possible
What might happen if I take too much NIPRIDE RTU?
Overdosage of nitroprusside can be manifested as excessive hypotension or cyanide toxicity or as thiocyanate toxicity . Cyanide toxicity causes venous hyperoxemia with bright red venous blood. Cells become unable to extract the oxygen delivered to them, leading to air hunger, confusion and death. Lactic acidosis may occur, but its emergence may lag other life-threatening manifestations of cyanide toxicity.
Cyanide levels can be measured by many laboratories, and blood-gas studies that can detect venous hyperoxemia or acidosis are widely available. Acidosis may not appear until more than an hour after the appearance of dangerous cyanide levels. Suspicion of cyanide toxicity is adequate grounds for initiation of treatment.
Treatment of cyanide toxicity consists of:
Hemodialysis is ineffective in removal of cyanide, but it will eliminate most thiocyanate.
Sodium nitrite is available in a 3% solution, and 4-6 mg/kg (about 0.2 mL/kg) should be injected over 2-4 minutes. This dose can be expected to convert about 10% of the patient’s hemoglobin into methemoglobin; this level of methemoglobinemia is not associated with any important hazard of its own.
Immediately after infusion of the sodium nitrite, sodium thiosulfate should be infused. This agent is available in 10% and 25% solutions, and the recommended dose is 150-200 mg/kg; a typical adult dose is 50 mL of the 25% solution. Thiosulfate treatment of an acutely cyanide-toxic patient will raise thiocyanate levels, but not to a dangerous degree.
The nitrite/thiosulfate regimen may be repeated, at half the original doses, after two hours.
Cyanide antidote kits are available.
How should I store and handle NIPRIDE RTU?
Store at room temperature 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C and 30°C (between 59°F and 86°F). NIPRIDE RTU is supplied in amber-colored, single-dose, 50 mg/100 mL (0.5 mg/mL) Fliptop Vials (NDC 51754-1006-1) and 10 mg/50 mL (0.2 mg/mL) Fliptop Vials (NDC 51754-1018-1). Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].To protect NIPRIDE RTU from light, vial should be stored in its carton until used.NIPRIDE RTU is supplied in amber-colored, single-dose, 50 mg/100 mL (0.5 mg/mL) Fliptop Vials (NDC 51754-1006-1) and 10 mg/50 mL (0.2 mg/mL) Fliptop Vials (NDC 51754-1018-1). Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].To protect NIPRIDE RTU from light, vial should be stored in its carton until used.NIPRIDE RTU is supplied in amber-colored, single-dose, 50 mg/100 mL (0.5 mg/mL) Fliptop Vials (NDC 51754-1006-1) and 10 mg/50 mL (0.2 mg/mL) Fliptop Vials (NDC 51754-1018-1). Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].To protect NIPRIDE RTU from light, vial should be stored in its carton until used.
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
Sodium nitroprusside interacts with oxyhemoglobin to produce methemoglobin, cyanide, and nitric oxide (NO). NO then reacts with guanylate cyclase in vascular smooth muscle to produce cGMP that reduces intracellular calcium concentrations resulting in relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins. Other smooth muscle (e.g., uterus, duodenum) is not affected. Sodium nitroprusside is more active on veins than on arteries, but this selectivity is much less marked than that of nitroglycerin. Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end diastolic pressure and pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Dilatation of the coronary arteries also occurs.
Non-Clinical Toxicology
Diseases with compensatory hypertension (e.g. coarctation of the aorta, arteriovenous shunting) ().Inadequate cerebral circulation or moribund patients (A.S.A. Class 5E) coming to emergency surgery ().
Congenital (Leber’s) optic atrophy or tobacco amblyopia ().
Acute heart failure with reduced peripheral vascular resistance ().
Concomitant use with sildenafil, tadalafil, vardenifil, or riociguat ()
(A) EXCESSIVE HYPOTENSION:
Sodium Nitroprusside can cause precipitous decreases in blood pressure which can lead to irreversible ischemic injuries or death. Use only with continuous blood pressure monitoring
(B) CYANIDE TOXICITY:
Sodium nitroprusside metabolism produces dose-related cyanide, which can be lethal. A patient’s ability to buffer cyanide will be exceeded in less than one hour at the maximum dose rate (10 mcg/kg/min); limit infusions at the maximum rate to as short a duration as possible
Careful observation is required when amantadine hydrochloride is administered concurrently with central nervous system stimulants.
Agents with anticholinergic properties may potentiate the anticholinergic-like side effects of amantadine.
Coadministration of thioridazine has been reported to worsen the tremor in elderly patients with Parkinson's disease, however, it is not known if other phenothiazines produce a similar response.
Coadministration of Dyazide (triamterene/hydrochlorothiazide) resulted in a higher plasma amantadine concentration in a 61-year-old man receiving amantadine hydrochloride 100 mg TID for Parkinson's disease. It is not known which of the components of Dyazide contributed to the observation or if related drugs produce a similar response.
Coadministration of quinine or quinidine with amantadine was shown to reduce the renal clearance of amantadine by about 30%.
The concurrent use of amantadine hydrochloride with live attenuated influenza vaccine (LAIV) intranasal has not been evaluated. However, because of the potential for interference between these products, LAIV should not be administered within 2 weeks before or 48 hours after administration of amantadine hydrochloride, unless medically indicated. The concern about possible interference arises from the potential for antiviral drugs to inhibit replication of live vaccine virus. Trivalent inactivated influenza vaccine can be administered at any time relative to use of amantadine hydrochloride.
Sodium nitroprusside, can cause excessive hypotension leading to hypoperfusion of vital organs. Hypotension should resolve within 1-10 minutes after discontinuation of the nitroprusside infusion; during these few minutes, it may be helpful to put the patient into a head-down (Trendelenburg) position to maximize venous return. If hypotension persists more than a few minutes after discontinuation, consider other causes. Elderly patients may be more sensitive to the hypotensive effects of the drug.
The following adverse reactions are described, or described in greater detail, in other sections:
Less common adverse reactions include:
Cardiovascular:
Bradycardia, electrocardiographic changes, tachycardia, palpitations, retrosternal discomfort
Dermatologic:
Endocrine:
Gastrointestinal:
Hematologic:
Musculoskelatal:
Neurologic:
Miscellaneous:
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
While we update our database periodically, we cannot guarantee it is always updated to the latest version.
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