is the chemical compound
with the formula
O. This salt serves as a source of nitric oxide
, a potent peripheral vasodilator
that affects both arterioles
(venules more than arterioles). Sodium nitroprusside is often administered intravenously
to patients who are experiencing a hypertensive emergency
"Nitroprusside" is an anion
that is usually available as the dihydrated
disodium salt, Na2
O. This red solid dissolves in water, and to a lesser extent in alcohol to give a solution containing the dianion
. This metal nitrosyl
complex is the active agent. In this anion, the iron is octahedral
, surrounded by five tightly bound cyanide
ligands and one linear nitric oxide
ligand. When the linear nitrosyl ligand is assigned a single positive charge, the iron is assigned an oxidation state of 2+. As such it has a low-spin
electron configuration, and is diaamagnetic
. Its chemical reactions have been studied intensively.
It reduces both total peripheral resistance as well as venous return, thus decreasing both preload
. For this reason, it can be used in severe cardiogenic heart failure where this combination of effects can act to increase cardiac output. In situations where cardiac output is normal, the effect is to reduce blood pressure
Nitroprusside is light-sensitive, and breaks down in sunlight, producing cyanide.
Despite its toxicity, nitroprusside is still used because it remains an effective drug in certain clinical circumstances such as malignant hypertension or for rapid control of blood pressure during vascular surgery and neurosurgery.
Nitroprusside is contraindicated in patients with renal failure.
Mechanism of action
Its mechanism of action appears to be liberation of nitric oxide
(NO), which causes relaxation of vascular smooth muscle. Nitroprusside also releases cyanide
ions which are converted in the liver to thiocyanate
by the enzyme rhodanase
, a reaction which requires a sulfur donor such as thiosulfate
. Alternatively, cyanide may react with methemoglobin to form cyanomethemoglobin. Thiocyanate
is then excreted by the kidney. In the absence of sufficient thiosulfate, cyanide ions can quickly reach toxic levels.
The half-life of nitroprusside is 1-2 minutes although thiocyanate has an excretion half life of several days. The duration of treatment should not exceed 72 hours and thiocyanate plasma concentrations should be monitored.
Role in research
Sodium nitroprusside (often abbreviated SNP) is frequently used in vascular research to test endothelium-independent vasodilation. One method of administering SNP is by iontophoresis
. This allows local administration of the drug, preventing the systemic effects listed above but still causing local microvascular vasodilation. NO liberated from the SNP diffuses into the vascular smooth muscle causing relaxation and subsequent vasodilatation. This vasodilatation is quantified by various techniques. This role in the treatment of hypertension was first performed at the Cleveland Clinic