NEO-LIDOCATON 2% Price

Overview

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This medicine contains an important and useful components, as it consists of
Lidocaine HCl, Lypressin, Noradrenalineis available in the market in concentration

Name

Sodium Nitroprusside Dihydrate

Precaution

Before using **Sodium Nitroprusside Dihydrate**, it is essential for patients to consult with their healthcare provider due to the potential risks associated with this potent vasodilator. Key precautions include: - **Hypotension risk**: Sodium Nitroprusside is a powerful **vasodilator**, which can cause a **significant drop in blood pressure**. Close monitoring of **blood pressure** during administration is necessary, particularly in patients who are prone to hypotension or those receiving other antihypertensive agents. - **Renal and hepatic function**: In patients with impaired **renal or hepatic function**, there may be an increased risk of **accumulation** of toxic metabolites, such as **cyanide**, as Sodium Nitroprusside is metabolized in the liver and kidneys. Caution is required when administering the drug to these patients. - **Thiocyanate and cyanide toxicity**: Prolonged or high-dose use of Sodium Nitroprusside may lead to **cyanide poisoning**. This can occur particularly in patients with **renal failure** or those receiving prolonged infusions. **Thiocyanate toxicity** can also develop, especially in those with compromised renal function. - **Pregnancy and breastfeeding**: Sodium Nitroprusside should be used during **pregnancy** only if absolutely necessary and under strict medical supervision, as it can reduce uterine blood flow and cause fetal harm. It is also excreted in breast milk, so caution is advised in breastfeeding mothers. - **Severe coronary artery disease**: Caution is warranted in patients with severe **coronary artery disease** (CAD), as the sudden vasodilation could lead to **reflex tachycardia** and worsen **myocardial ischemia**.

Indication

Sodium Nitroprusside Dihydrate is primarily used in emergency settings for the management of **hypertensive crises** and other conditions requiring rapid **blood pressure reduction**. Its key indications include: - **Hypertensive emergencies**: Sodium Nitroprusside is indicated in patients with **severe hypertension** who require rapid and controlled reduction of blood pressure. It is commonly used when immediate blood pressure lowering is essential to prevent end-organ damage such as **stroke**, **heart failure**, or **renal failure**. - **Acute heart failure**: It is used to **reduce preload and afterload** in patients with **acute heart failure**, particularly those who exhibit **pulmonary edema**. The vasodilating properties help to decrease cardiac workload and improve oxygen delivery to tissues. - **Controlled hypotension during surgery**: Sodium Nitroprusside is also used in **surgical procedures** where a transient and controlled drop in blood pressure is needed to facilitate surgery (e.g., in neurosurgery or cardiac surgery). - **Coronary artery disease and ischemia**: In some cases, it is used as an adjunct treatment in patients with **coronary artery disease** (CAD) to control ischemic pain or reduce **angina** symptoms when other options are inadequate.

Contra indication

Sodium Nitroprusside should be avoided in the following conditions: - **Hypersensitivity**: It should not be used in patients with known hypersensitivity to **Sodium Nitroprusside** or any of its components. - **Severe hypotension**: Sodium Nitroprusside is contraindicated in patients with severe **hypotension** or a **shock state** where blood pressure is already dangerously low, as it may worsen the condition. - **Cyanide toxicity**: Sodium Nitroprusside should not be used in patients with **cyanide toxicity** or those at high risk of developing it, such as those with **renal impairment** or **hepatic dysfunction**, as the drug can cause **cyanide accumulation**. - **Adrenal insufficiency**: Sodium Nitroprusside should not be used in patients with **Addison's disease** or other forms of **adrenal insufficiency**, as it may lead to dangerous drops in blood pressure. - **Pregnancy (except in emergencies)**: Use of Sodium Nitroprusside during pregnancy should be avoided unless absolutely necessary, as it can reduce uterine blood flow and negatively affect the fetus.

Side Effect

Sodium Nitroprusside Dihydrate can cause both common and severe side effects, including: - **Hypotension**: The most common side effect is **hypotension** (low blood pressure), especially if the infusion rate is too high. Symptoms include **dizziness**, **lightheadedness**, **fainting**, or **shock**. - **Cyanide toxicity**: Prolonged or high-dose use of Sodium Nitroprusside may result in **cyanide toxicity**, with symptoms such as **confusion**, **headache**, **nausea**, **vomiting**, **shortness of breath**, **seizures**, or even **coma**. This is particularly a concern in patients with **renal failure**. - **Thiocyanate toxicity**: Chronic use or overdose can lead to **thiocyanate toxicity**, with symptoms such as **lethargy**, **nausea**, **vomiting**, **muscle weakness**, or **hypothyroidism**. It can also cause **elevated blood levels of thiocyanate**. - **Reflex tachycardia**: The drop in blood pressure can trigger **reflex tachycardia** (an increased heart rate), which may be particularly problematic in patients with **coronary artery disease**. - **Nausea and vomiting**: These gastrointestinal symptoms can occur, especially in patients with high doses or prolonged infusions. - **Injection site reactions**: When administered intravenously, Sodium Nitroprusside can cause irritation, pain, or redness at the injection site.

Pregnancy Category ID

3

Mode of Action

Sodium Nitroprusside acts as a **potent vasodilator** by increasing the availability of **nitric oxide** (NO), which leads to the relaxation of smooth muscle in blood vessels. Its mechanism of action involves the following steps: - **Nitric oxide release**: Sodium Nitroprusside is metabolized in the body to release **nitric oxide**, which stimulates the enzyme **guanylate cyclase**. This enzyme increases the levels of **cyclic GMP (cGMP)**, which leads to the relaxation of smooth muscle cells in the vascular walls. - **Vasodilation**: This relaxation causes **arterial and venous dilation**, reducing both **preload** and **afterload** (the resistance the heart must overcome to pump blood). The reduction in vascular tone leads to **lowered blood pressure**. - **Rapid onset**: The vasodilatory effects of Sodium Nitroprusside occur almost immediately after administration, making it an effective agent for **acute blood pressure control** in hypertensive crises or surgery. - **Cyanide and thiocyanate formation**: During metabolism, Sodium Nitroprusside releases **cyanide** ions, which can be toxic if not adequately cleared from the body. The drug also forms **thiocyanate**, which can accumulate with prolonged use.

Interaction

Sodium Nitroprusside may interact with several medications or substances, potentially affecting its efficacy or safety: - **Other antihypertensives**: When used with other **antihypertensive medications**, such as **ACE inhibitors**, **beta-blockers**, or **calcium channel blockers**, there may be an enhanced effect of blood pressure lowering, increasing the risk of **hypotension** and potential **syncope**. - **Alcohol**: Consumption of **alcohol** may increase the **vasodilatory effects** of Sodium Nitroprusside, leading to excessive **hypotension**. It is recommended to avoid alcohol during treatment. - **Cyanide-producing drugs**: Concomitant use of **cyanide-producing agents**, such as **nitrites** or **sulfonamides**, can increase the risk of **cyanide toxicity**, as Sodium Nitroprusside is metabolized to cyanide in the body. - **Heparin**: There may be an increased risk of **bleeding** when Sodium Nitroprusside is administered with **heparin** or other anticoagulants, particularly in patients undergoing surgery or in intensive care settings. - **Thiocyanate**: Long-term use of Sodium Nitroprusside may lead to **thiocyanate accumulation**, especially in patients with renal failure, and should be monitored carefully for toxicity.

Pregnancy Category Note

Information not available

Adult Dose

The typical dosage of **Sodium Nitroprusside** in adults varies based on the condition being treated: - **Hypertensive emergency**: Initial infusion rate is typically **0.3 to 0.5 mcg/kg/min**, and may be gradually increased every 2 to 5 minutes to achieve the desired blood pressure reduction. Doses can be adjusted based on the patient's response, but the infusion rate should not exceed **10 mcg/kg/min**. - **Acute heart failure**: Sodium Nitroprusside can be infused at rates similar to those used for hypertensive emergencies, typically starting at **0.3 to 0.5 mcg/kg/min** and titrated to the desired hemodynamic effect. - **Surgical use**: In controlled hypotension during surgery, doses may start at **0.5 mcg/kg/min** and be titrated based on the surgical requirements and the patient's response.

Child Dose

In pediatric patients, the use of **Sodium Nitroprusside** requires careful dosing: - **Hypertensive emergencies**: The usual starting dose is **0.3 mcg/kg/min**, and the dose can be titrated upward as necessary, typically within the range of **0.5 to 10 mcg/kg/min**, depending on the child's response and condition. - **Monitoring**: Continuous monitoring of **blood pressure**, **electrolyte levels**, and **renal function** is critical in pediatric patients due to the risks of **cyanide** and **thiocyanate toxicity**. Given its potent effects, it is critical that healthcare providers carefully monitor Sodium Nitroprusside administration, particularly in high-risk populations.

Renal Dose

In patients with **renal impairment**, Sodium Nitroprusside must be used with extreme caution: - **Renal failure**: In patients with impaired kidney function, **cyanide** and **thiocyanate** may accumulate more readily, leading to toxicity. Close monitoring of **renal function**, **cyanide levels**, and **thiocyanate levels** is necessary. - **Dose adjustment**: Although no specific dosage adjustments are given for renal dysfunction, **lower doses** and **shorter infusion times** are often recommended, and **close monitoring** is mandatory.

Administration

Information not available