Has arteriodilatirtee, venodilatiruyuschee and antihypertensive effect.
The effect of the drug is expressed as follows:
Reduces the tone of arteries and veins by direct myotropic action. Expanding peripheral arterial vessels, sodium nitroprusside reduces afterload, reduces left ventricular filling pressure, lowers blood pressure (BP). Expanding testosterone enanthate dosage perifercheskie veins reduces the preload on the heart that holds to improve the system and intracardiac hemodynamics, reduce the pressure in the pulmonary circulation. In some cases, causing reflex tachycardia. The antihypertensive effect develops in the first minute after the on / in the introduction. Short duration of action of the drug due to rapid metabolism in blood. The mechanism of action associated with the activation of guanylate cyclase like and with an increase in intracellular cyclic guanosine monophosphate, and to the suppression of calcium ion current (direct inhibition of entry of calcium ions through the slow channel) and the violation of the phosphorylation of myosin.
When i / in the introduction of sodium nitroprusside is rapidly distributed and reaches a volume corresponding to the extracellular space of the distribution (volume). Completely metabolized in several minutes erythrocyte enzymes to form iron ions, cyanides and methemoglobin. Methemoglobin, and cyanide are released slowly into the blood plasma from red blood cells and reaches the liver, it is transformed into thiocyanate thiosulfate and with the participation of the enzyme rodanazy. Thiocyanate excreted by the kidneys. It penetrates the blood-brain and placental barriers, a small amount is excreted in breast milk.
- hypertensive crisis
- acute left ventricular failure with pulmonary edema
- controlled hypotension during surgery, in order to reduce operative blood loss
- acute heart failure if necessary rapid reduction of afterload of the left ventricle, to reduce left ventricular filling pressure.
- Hypersensitivity to the active or excipient;
- Symptomatic (compensatory), hypertension (with arteriovenous shunt or coarctation of the aorta);
- Acute ischemic attack;
- Increased intracranial pressure;
- Chronic heart failure associated with decreased peripheral vascular resistance;
- Aortic stenosis:
- Hypothyroidism (thiocyanate inhibits the uptake and binding of iodine);
- Hypovitaminosis vitamin B | 2;
- Deficit sulforiltransferazy (rodanazy) in patients with ocular atrophy Leber;
- Atrophy of the optic nerve;
- Severe liver and / or kidney failure;
- Pregnancy, lactation.
In emergency situations (for “real life” testimony), these contraindications are relative.
It should be used with caution in patients with hypothermia, hyponatremia, coronary heart disease and in the elderly.
Dosage and administration
intravenously by infusion.
Naniprus treatment is carried out in a hospital with moniterirovaniya blood pressure, resuscitation and the availability of funds to deal with cyanide intoxication.
Intravenous bolus Naniprus contraindicated!
Naniprus as a lyophilized powder to be used for preparation of the diluted infusion solution only.
Preparation of solution
infusion solution is prepared immediately before use (do not use the solution later than 4 hours after cooking).
Dilute the contents of 1 vial of the drug in a solvent (enclosed in the kit). The mixed solution was further diluted with 500 mL of 5% dextrose (glucose) solution or 0.9% sodium chloride solution preventing from exposure to light. Infusion is performed by means of an infusion pump with continuous blood testosterone enanthate dosage pressure monitoring. The infusion solution should not be mixed with other drugs!
The dose is determined individually at constant blood pressure monitoring.
Adults: for patients not receiving antigipertenzivngh means, the dose is usually 3 ug / kg / min. Initial dose: 0.3-1.5 ug / kg / min. Gradually increase the dose (0.5 mcg / kg / min every 5 minutes) to achieve an antihypertensive effect. The dose is adapted so that the reduction in blood pressure during the first hour of infusion does not exceed 25% of the original level because of the risk of myocardial ischemia, brain or kidney. The maximum dose for adults is 8-10 mcg / kg / min.
When administering for 10 min at 10 mg / kg per 1 m is not adequate lowering of blood pressure, it is recommended to immediately stop the infusion.
Do not exceed the dose of 500 mcg / min.
For the control of hypotension during surgery, or in patients receiving means antigipertenzivngh for 3 hour prior to infusion, the total dose sufficient to introduce 1 mg / kg body weight.
To avoid compensatory response (rapid increase in catecholamines and renin, tachycardia), especially in young patients, the dose should be increased gradually until the desired therapeutic effect. injection speed is also gradually reduced in the range of 10-30 minutes to prevent a sharp rise in blood pressure.
Children: experience of Naniprus in children is limited. The usual dosage is the same as for adult patients.
Elderly patients (over 65 years) are treated with low doses, since elderly patients are more sensitive to the drug (more rapid development of the antihypertensive effect).
Duration of treatment
Upon reaching the antihypertensive effect of the introduction should last only a few hours to avoid the risk of cyanide intoxication. Naniprus Treatment should not last more than 72 hours. After the need to start treatment alternative antihypertensive drugs for oral administration.
The initial dose should be 10-15 g / minute, with a gradual increase every 5-10 minutes at 10-15 g / min. If necessary to achieve satisfactory therapeutic effect, the dose may be increased in the range of 10-200 mcg / min. If during the injection will be observed symptoms of hypotension, hypoperfusion, or some other side effects infusion rate necessary to reduce or stop the introduction.
Infusion administration may continue until safe transition to therapy inside. Usually infusion administration should not exceed 3 days.
Side effects of the drug due to the ability to rapidly and significantly reduce blood pressure and toxicity of its major metabolites (cyanide and thiocyanate).
There may be nausea, vomiting, sweating, headache, anxiety, dizziness, muscle spasms, hyperreflexia, rapid decline in blood pressure, tachycardia, bradycardia, discomfort in the chest, pain in the abdomen, when used in excessive doses – intoxication development cyanide (vomiting , loss of consciousness, tissue hypoxia), with the rapid cessation of infusion – “ricochet” syndrome. These symptoms disappear when slowing the infusion rate or temporary cessation of infusion.
Rare: decrease in platelet count.
Very rare: skin rash, pruritus, erythema (require stopping the infusion); hypothyroidism.
Reactions at the injection site: redness, swelling, acute phlebitis.
The first signs of overdose associated with a marked reduction of blood pressure. Sometimes the development of lactate acidosis may be an early symptom of overdose. In severe overdose in blood plasma increased levels of cyanide.
In case of overdose symptoms immediately conduct Naniprus infusion is stopped. The antidote can be applied as a 1% solution of sodium nitrite in combination with testosterone enanthate dosage 20-50 ml of a solution of sodium thiosulfate (12.5 g in 50 ml of 5% dextrose (glucose) respiratory resuscitation, oxygen and symptomatic agents -. Analeptics, cardiovascular drugs , aqueous salt solutions, means correcting the acid-base balance, oksikobalamin 2.5 g (2.5 g in 100 ml of 0.9% sodium chloride solution) for 7.5 min.
Interaction with other drugs
Ganglioplegic, general anesthetics, beta-blockers, diuretics, blockers “slow” calcium channels (diltiazem), angiotensin converting enzyme inhibitors (captopril) may enhance the antihypertensive effect of sodium nitroprusside. Since sodium nitroprusside is nitric oxide donators, can not be used in conjunction with phosphodiesterase-5 inhibitors (sildenafil, vardenafil, tadalafil). In a joint application with estrogens or sympathomimetics decreased antihypertensive effect Naniprus.
Never mix Naniprus infusion solution with other drugs.
of hypertensive crisis, with concomitant cerebrovascular events, is not an indication for treatment Naniprus. The decision is made in the presence of visceral complications with immediate life-threatening.Patients with hyponatremia and impaired renal function, prolonged treatment Naniprus may result in higher plasma concentrations of the major metabolite thiocyanate. Since the latter inhibits the absorption of iodine from the thyroid gland, can manifest symptoms of hypothyroidism.
In young patients to prevent severe compensatory response associated with a sharp increase in the levels of catecholamines and renin, and an increase in dose reduction is carried out gradually. The entire infusion system should be isolated from direct sunlight by a black plastic bag.
Effects on ability to drive vehicles and management mechanisms
The drug is used only in stationary conditions.
Valium for solution for infusion 30 mg together with the solvent (water for injection)
The lyophilisate in an amount equivalent to 30 mg sodium nitroprusside dihydrate is placed in a dark glass vials of 10 ml capacity. 5 ml of solvent (water for injection) are placed in clear glass 5ml ampoules capacity.
One vial of lyophilisate one vial with a solvent and black plastic bag to protect the drug from light, along with instructions placed into cardboard pack. cialis with dapoxetine 60mg