Unresponsive CHF secondary to acute MI, left-sided heart failure. Refractory unstable angina pectoris & coronary insufficiency including Prinzmetal's angina. Control of hypertensive episodes &/or myocardial ischemia during & after cardiac surgery. Induction of controlled hypotension for surgery.
Adult 10-200 mcg/min up to max: 400 mcg/min may be necessary during surgical procedures. Control of HTN or production of hypotension during surgery Initially 25 mcg/min, may be increased by increments of 25 mcg/min at 5-min intervals until BP is stabilized. Max: 10-400 mcg/min. Peri-op myocardial ischaemia Initially 15-20 mcg/min w/ subsequent increments of 10-15 mcg/min. Unresponsive CHF Initially 20-25 mcg/min, may be decreased to 10 mcg/min or increased in steps of 20-25 mcg/min every 15-30 min. Unstable angina Initially 10 mcg/min w/ increments of 10 mcg/min at approx 30-min intervals.
Not to be given by bolus inj. Low filling pressures eg, in acute MI, impaired left ventricular function (left ventricular failure); orthostatic dysfunction. Development of tolerance & cross tolerance to other nitro compds. Hypothermia, hypothyroidism; DM; arterial hypoxemia due to severe anemia, hypoxemia & ventilation/perfusion imbalance due to lung disease or ischemic heart failure; angina pectoris, MI; cerebral ischemia; methemoglobinemia. Avoid reducing systolic BP <90 mmHg. Closely monitor haemodynamic parameters during therapy. Not to be used concomitantly w/ PDE5 inhibitors eg, sildenafil, vardenafil, tadalafil. Avoid use w/ alcohol. Combination w/ polyvinyl Cl- or polyurethane-containing infusion materials. May affect ability to drive & use machines. Severe renal & hepatic disease or impairment. Lactation. Childn.
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