Acebutolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Drug reference
Sodium nitroprusside
Vasodilator · Antihypertensive
VasodilatorAntihypertensive
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
—
none in our sources
PREGNANCY
—
not curated
Mechanism
Sodium nitroprusside is a vasodilator. It exerts a potent hypotensive effect.
Indications
Hypertensive emergenciesControl of severe hypertensive emergencies when parenteral treatment is necessaryhypertensionacute decompensated heart failureShort-term reduction of cardiac preload or afterloadImprove cardiac output in congestive heart failure (especially in hypertensive patients with pulmonary edema)Decrease myocardial O2 demand after acute MIControlled hypotension during anesthesiatideover crisis in severely decompensated patients (in conjunction with a loop diuretic + i.v. inotropic drug)symptomatic treatment of acute heart failureControlled hypotensionRefractory CHFPump failure accompanying MIAcute mitral regurgitation
Dosing
- Adult
- BY INTRAVENOUS INFUSION: Initially 0.5–1.5 micrograms/kg/minute, adjusted in steps of 500 nanograms/kg/minute every 5 minutes, usual dose 0.5–8 micrograms/kg/minute. Use lower doses if already receiving other antihypertensives. Stop if response unsatisfactory with max. dose in 10 minutes.
- Max dose
- 8 micrograms/kg/minute
Pharmacokinetics
Onset
Within 30 seconds; peak hypotensive effect within 2 minutes.
Duration
Effect disappears within 3 minutes after stopping infusion
Metabolism
By smooth muscle, initiated by reduction, releases cyanide then NO. Cyanide metabolized by hepatic rhodanase to thiocyanate.
Contraindications
- systolic blood pressure <110 mmHg
- eclampsia
Side effects
Common
Hypotension (due to excessive vasodilation)palpitationnervousnessvomitingperspirationpain in abdomenweaknessdisorientation
Serious
- cyanide toxicity
- methemoglobinemia
- hypotension
- Cyanide intoxication (from conversion to cyanide, leading to severe lactic acidosis; usually >5 μg/kg/min, or >2 μg/kg/min for prolonged periods)
- Thiocyanate toxicity (with prolonged infusions >24-48 hours, especially with renal impairment: anorexia, nausea, fatigue, disorientation, toxic psychosis, hypothyroidism)
- Worsening arterial hypoxemia (in COPD patients, due to interference with hypoxic pulmonary vasoconstriction)
- lactic acidosis (caused by cyanide release)
- psychosis (from thiocyanate toxicity with large doses >1-2 days)
Drug interactions
Atenolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Betaxolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Bisoprolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Bucindolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Carteolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Carvedilol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Celiprolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Esmolol Hydrochloride
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Esmolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Labetalol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Levobunolol
Moderate
Textbook
In acute aortic dissection, nitroprusside alone can enhance propagation of the dissection.
In the treatment of acute aortic dissection, it is important to administer a beta blocker with nitroprusside.
Source: G&G 14e
Related guidelines
Other Vasodilator drugs
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-10 · House clinical team