NANIPRUS ampoules 30 mg. 10 ml.

Naniprus is a medicine for rapid lowering of blood pressure. It dilates blood vessels (arteries and veins), thereby relieving the work of the heart. The effect was short-lived due to rapid degradation in the blood.
 
INDICATIONS
In what cases is used Naniprus?
Rapid reduction of blood pressure in patients with life-threatening hypertensive crisis.
Maintaining a low blood pressure (controlled hypotension) during surgery in order to reduce operative blood loss.
Treatment of acute heart failure, treatment during and after cardiac surgery.
 
CONTRAINDICATIONS:
When should not be used Naniprus?
Naniprus should not apply in the case of hypersensitivity to the product; impaired cerebral blood flow, intracranial pressure, low blood pressure (hypotension), decreased blood volume (hypovolemia), decreased thyroid function, expressed a lack of vitamin B12. symptomatic hypertension, liver failure.
 
SPECIAL WARNINGS AND PRECAUTIONS
Naniprus should be used with caution in patients with hyponatremia (low blood sodium), renal failure, decreased thyroid function (hypothyroidism).
In younger patients, to prevent the compensatory increase in blood pressure, the dose should be increased gradually.
Since sodium nitroprusside may affect metabolism of vitamin B12, the product should be used with caution in patients with a deficiency of vitamin B12.
Due to the high light sensitivity of Naniprus, the infusion set should be protected from direct light.
 
Discontinuation of therapy
Intravenous infusion should not be discontinued abruptly and for 5-30 min. To avoid a sharp increase in blood pressure.
Use in pregnancy and lactation
During pregnancy should be carefully weighed against the benefit / risk in the use of Naniprus. If treatment of breastfeeding, breastfeeding should be discontinued.
Effects on ability to drive and use machines
The drug is administered only in hospital.
 
DRUG INTERACTIONS AND OTHER
Drugs that affect the autonomic nervous system (ganglioblokeri) for obshtanarkoza in surgery (general anesthetics), drugs that inhibit blood circulation may enhance the hypotensive effect of sodium nitroprusside.
Sodium nitroprusside should not be co-administered with sildenafil (Viagra).
 
METHOD AND DOSAGE
Dosage is determined individually by the physician. Treatment is carried out under strict medical supervision in hospital. Dose is gradually increased, to achieve the desired effect. Older patients are more sensitive to the usual doses of the product.




OVERDOSE
Overdose is rare and can occur during prolonged therapy. Symptoms: rapid breathing, headache, vomiting, dizziness, pink coloration of the skin, shallow breathing with weak pulse, dilated pupils with absence of pupil reflexes.
Treatment: It is aimed at maintaining vital functions.
SIDE EFFECTS
The most significant side effects on the product are associated with its ability to rapidly and significantly lowers the blood pressure or the toxicity of its main metabolites cyanide and thiocyanate. ADRs observed as: nausea, vomiting, sweating, headache, dizziness, muscle spasms, hyperreflexia, rapid heart rate (tachycardia), chest pain, abdominal pain. These symptoms disappear in slowing the infusion rate or suspend infusion.
Very rarely can be observed: skin rashes, pruritus, erythema (requiring discontinuation of the infusion); lowering functions of the thyroid (hypothyroidism). Injection site can be redness, swelling.
FOR SUPPLY
• For hospital use only!
 
STORAGE:
In original container, dry and protected from light, at a temperature below 25 ° C. Keep out of reach of children!
 
EXPIRY DATE
Do not use after the expiry date stated on the packaging!
 
Physician information!
The treatment is done in a hospital setting with the possibility of blood pressure monitoring, resuscitation and means to combat cyanide intoxication.
Method of administration: intravenous form of infusion. Intravenous bolus administration of sodium nitroprusside is contraindicated! Sodium nitroprusside in the form of a lyophilized powder to be used only for the preparation of a dilute solution for infusion.
Reconstitution: Dust from amber glass ampoules, mixed with the supplied solvent ampoule of colorless. Thus prepared solution was added to the bottle containing between 500 ml of 5% glucose solution or 0.9% solution of sodium chloratum. Bank covered with an opaque material (black polyethylene bag packaging) to protect the solution from light. This reconstituted solution was used immediately, not later than 4 hours. Infusion should be made with an infusion pump for continuous monitoring of blood pressure. The infusion solution should not be mixed with other drugs!
Dosage is determined on a continuous blood pressure monitoring. Adults: For patients who are not treated with other antihypertensive agents, the usual dose is 3 mcg / kg / min. The starting dose is 0,3-1,5 mcg / kg / min. The dosage is gradually increased (by 0,5 mcg / kg / min every 5 minutes) to achieve the desired antihypertensive effect. The dose should be adjusted so that the reduction of blood pressure during the first hour of infusion should not exceed 25% of the baseline due to risk of myocardial, cerebral or renal ischemia. The maximum dose for adults is 8-10 mcg / kg / min. In case you do not achieve the antihypertensive effect in the first 10-15 minutes at a dose of 8-10 mcg / kg / min infusion is discontinued. Do not exceed the dose of 500 mcg / min.
To avoid compensatory response (sharp increase of catecholamines, and renin, tachycardia), especially in young patients, the dose should be gradually increased until the desired effect. The infusion rate should be reduced gradually also within 10-30 min, to avoid a sharp increase in blood pressure.
 
Children: Experience in the treatment of children with sodium nitroprusside is limited.
The usual dosage is the same as in adults. Elderly (over 65 years):
In elderly patients lechenietozapochva low doses, as they are more sensitive to the antihypertensive effect of the drug.
Duration of treatment: In case of response ideally infusion should last only a few hours to avoid the risk of cyanide intoxication. Alternatively oral antihypertensive therapy should be initiated at the earliest opportunity. Treatment with sodium nitroprusside should not last more than 72 hours.