Risk Factor: C
Class: Cardiovascular drugs/ Antihypertensives/ Other antihypertensives
Fetal Risk Summary
No reports linking the use of sodium nitroprusside with congenital defects have been located. Nitroprusside has been used in pregnancy to produce deliberate hypotension during aneurysm surgery or to treat severe hypertension (1,2,3,4,6,7 and 8). Transient fetal bradycardia was the only adverse effect noted (1). One advantage of nitroprusside is the very rapid onset of action and the return to pretreatment blood pressure levels when the drug is stopped (8). Balanced against this is the potential accumulation of cyanide in the fetus.
Nitroprusside crosses the placenta and produces fetal cyanide concentrations higher than maternal levels in animals (9). This effect has not been studied in humans. A 1984 article reviewed the potential fetal toxicity of nitroprusside (6). Avoidance of prolonged use and the monitoring of serum pH, plasma cyanide, red blood cell cyanide, and methemoglobin levels in the mother were recommended. Standard doses of nitroprusside apparently do not pose a major risk of excessive accumulation of cyanide in the fetal liver (6).
Breast Feeding Summary
No data are available.
- Donchin Y, Amirav B, Sahar A, Yarkoni S. Sodium nitroprusside for aneurysm surgery in pregnancy. Br J Anaesth 1978;50:84951.
- Paull J. Clinical report of the use of sodium nitroprusside in severe preeclampsia. Anesth Intensive Care 1975;3:72.
- Rigg D, McDonogh A. Use of sodium nitroprusside for deliberate hypotension during pregnancy. Br J Anaesth 1981;53:9857.
- Willoughby JS. Case reports: Sodium nitroprusside, pregnancy and multiple intracranial aneurysms. Anaesth Intensive Care 1984;12:35860.
- Stempel JE, O’Grady JP, Morton MJ, Johnson KA. Use of sodium nitroprusside in complications of gestational hypertension. Obstet Gynecol 1982;60:5338.
- Shoemaker CT, Meyers M. Sodium nitroprusside for control of severe hypertensive disease of pregnancy: a case report and discussion of potential toxicity. Am J Obstet Gynecol 1984;149:1713.
- Willoughby JS. Review article: sodium nitroprusside, pregnancy and multiple intracranial aneurysms. Anaesth Intensive Care 1984;12:3517.
- de Swiet M. Antihypertensive drugs in pregnancy. Br Med J 1985;291:3656.
- Lewis PE, Cefalo RC, Naulty JS, Rodkey RL. Placental transfer and fetal toxicity of sodium nitroprusside. Gynecol Invest 1977;8:46.