Sodium nitroprusside: A comprehensive systematic review of its role across various clinical settings

Abstract

Sodium nitroprusside (SNP) is one of the oldest, yet most powerful intravenous vasodilators used in acute cardiovascular care. Although newer vasoactive agents have been introduced, SNP continues to play a relevant role in clinical practice, particularly when rapid and tightly controlled hemodynamic modulation is required. In this systematic review, conducted according to PRISMA recommendations, we provide a comprehensive overview of the pharmacological profile, clinical applications, and safety considerations of SNP in acute heart failure (AHF), cardiogenic shock, hypertensive emergencies, and acute aortic dissection. Through nitric oxide-mediated activation of the cGMP pathway, SNP induces balanced arterial and venous vasodilation, leading to effective preload and afterload reduction and prompt blood pressure control. Available evidence suggests meaningful hemodynamic improvement in selected patients with advanced AHF, with observational data indicating possible survival benefits. In hypertensive crises and acute aortic syndromes, SNP remains an effective option for rapid blood pressure reduction and wall stress control, consistent with current guideline recommendations. However, concerns regarding cyanide and thiocyanate toxicity, particularly during high-dose or prolonged infusions, limit its extended use. Overall, SNP remains a valuable therapeutic tool, but a more individualized approach and well-designed randomized trials are needed to better define its long-term clinical impact in contemporary vascular pharmacotherapy.

Keywords: Aortic dissection; Arterial hypertension; Cardiogenic shock; Heart failure; Sodum nitroprusside.