Nitroprusside is a direct venous and arteriolar vasodilator and is very effective at lowering blood pressure. It has been used for the treatment of hypertensive emergencies for many years and most of are comfortable with using it.
The problems with the drug:
May cause precipitous drops in BP and lead to overshoot of BP target goals
The drug is inactivated by light so the infusion bag and tubing must be protected from light
Frequently causes nausea, vomiting, and muscle twitching
Most importantly, cyanide (CN) is released from nitroprusside in a dose-dependent fashion and may cause clinical toxicity
Good alternatives exist: Fenoldopam as an example. Just as effective and without any of these side effects.
References
Marik PE, etc. Hypertensive crises: challenges and management. Chest 2007;131:1949-62
