Sodium Nitroprusside as a Hyperinflation Drug and Therapeutic Alternatives

Abstract

Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as US$900 per vial, earning the drug its status as a "hyperinflation drug." Hyperinflation drugs pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective cost containment strategy. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy to address rising drug costs. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.

Therapeutic potential of nitric oxide in vascular aging due to the promotion of angiogenesis

“…SNP (Figure 2), a metal‐NO complex‐based NO donor drug, is used to lower blood pressure in clinical practice (Cobb & Thornton, 2018). In vitro, SNP releases NO in the presence of light, while in vivo, the release of NO can occur through either an enzymatic or non‐enzymatic process, such as the action of reducing substances (e.g., ascorbic acid) or certain enzymes.…”

“…Nitroglycerin (Figure 2) is an important NO donor for the treatment of angina, and organic nitrates, such as latanoprost, are used in the treatment of glaucoma (Hoy, 2018). SNP (Figure 2), a metal-NO complex-based NO donor drug, is used to lower blood pressure in clinical practice (Cobb & Thornton, 2018). In vitro, SNP releases NO in the presence of light, while in vivo, the release of NO can occur through either an enzymatic or non-enzymatic process, such as the action of reducing substances (e.g., ascorbic acid) or certain enzymes.…”

Nitric Oxide as a Central Molecule in Hypertension: Focus on the Vasorelaxant Activity of New Nitric Oxide Donors

“…One of the best-known NO donors is sodium nitroprusside (SNP), which presents a short half-life and high reactivity with oxygen [38]. SNP is an inorganic complex used, since 1928, as a vasodilator in hypertensive crisis and cardiovascular emergencies, such as angina pectoris and heart failure [131][132][133]. SNP also provides a controlled hypotensive effect during surgery [134].…”

Characteristic vibrational frequencies of osmium(ii) nitrosyl complexes probed by Raman spectroscopy and DFT calculations

“…36 Sodium nitroprusside (Na 2 [Fe(CN) 5 (NO)]) is one such prototypic system that has been abundantly studied for its photochemical properties, 19,22,23 and is in clinical use owing to its strong vasodilating activity. 37 This wide applicability makes the detailed characterization of metal-nitrosyl complexes important. One key characteristic are vibrational frequencies, and several reviews compile such data mainly obtained from IR spectra, but a few also from Raman spectra.…”

“…36 Sodium nitroprusside (Na 2 [Fe(CN) 5 (NO)]) is one such prototypic system that has been abundantly studied for its photochemical properties, 19,22,23 and is in clinical use owing to its strong vasodilating activity. 37…”