The Basics
What is Nitroprusside?
Indicated for the immediate reduction of blood pressure of adult and pediatric patients in hypertensive crises.
Brand names for Nitroprusside
Nitropress
How Nitroprusside is classified
Antihypertensive Agents, Vasodilator Agents
Nitroprusside During Pregnancy
Nitroprusside pregnancy category
Category CNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Nitroprusside while pregnant
There are no adequate, well-controlled studies of NITROPRESS in either laboratory animals or pregnant women. It is not known whether NITROPRESS can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. NITROPRESS should be given to a pregnant woman only if clearly needed.
Taking Nitroprusside While Breastfeeding
What are recommendations for lactation if you're taking Nitroprusside?
Breastmilk levels of nitroprusside sodium have not been measured after exogenous administration. Because of its short half-life of 2 minutes, it is unlikely to appear in breastmilk. However, its toxic metabolite, thiocyanate, is excreted into milk and can be directly toxic to the infant as well as inhibiting iodide transport into breastmilk. Cyanide is another toxic metabolite of nitroprusside that may enter breastmilk. An alternate drug is therefore preferred, during breastfeeding. If use of nitroprusside sodium is unavoidable, the mother should refrain from breastfeeding.
Maternal / infant drug levels
Breastmilk levels of nitroprusside sodium have not been measured after exogenous administration. Because of its short half-life of 2 minutes, it is unlikely to appear in breastmilk. However, its toxic metabolite, thiocyanate, is excreted into milk and can be directly toxic to the infant as well as inhibiting iodide transport into breastmilk. Cyanide is another toxic metabolite of nitroprusside that may enter breastmilk. An alternate drug is therefore preferred, during breastfeeding. If use of nitroprusside sodium is unavoidable, the mother should refrain from breastfeeding.
Possible effects of Nitroprusside on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Nitroprusside
Enalapril, Hydralazine, Hydrochlorothiazide, Methyldopa, Propranolol.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Dorea JG. Maternal thiocyanate and thyroid status during breast-feeding. J Am Coll Nutr. 2004;23:97-101. PMID: 15047674
2. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998;35:9-36. PMID: 9673832
3. Funderburk CF, Van Middlesworth L. Effect of lactation and perchlorate on thiocyanate metabolism. Am J Physiol. 1967;213:1371-7. PMID: 4294711
4. Meberg A, Sande H, Foss OP, Stenwig JT. Smoking during pregnancy–effects on the fetus and on thiocyanate levels in mother and baby. Acta Paediatr Scand. 1979;68:547-52. PMID: 463536
5. Dasgupta PK, Kirk AB, Dyke JV, Ohira S. Intake of iodine and perchlorate and excretion in human milk. Environ Sci Technol. 2008;42:8115-21. PMID: 19031911
6. Vanderpas J, Rivera MT, Berquist H, Thilly CH. Thiocyanate overload decreases iodine supply in iodine-deficient breast-fed infants. Horm Res. 2007;68 (Suppl 3):53-4.
7. Leung AM, Braverman LE, He X et al. Environmental perchlorate and thiocyanate exposures and infant serum thyroid function. Thyroid. 2012;22:938-43. PMID: 22827469
8. Laurberg P, Nohr SB, Pedersen KM, Fuglsang E. Iodine nutrition in breast-fed infants is impaired by maternal smoking. J Clin Endocrinol Metab. 2004;89:181-7. PMID: 14715847
9. Kirk AB, Dyke JV, Martin CF, Dasgupta PK. Temporal patterns in perchlorate, thiocyanate, and iodide excretion in human milk. Environ Health Perspect. 2007;115:182-6. PMID: 17384762
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
