Nitrates in Children and the Elderly

Vasodilators have been used extensively in infants and children, mainly to treat acute hemodynamic deterioration in hospitalized patients. Nitroprusside has traditionally been the most widely used vasodilator in the pediatric age group. The main indication for nitroprusside in infants and children is hypertensive emergencies. The drug has the advantage of being a balanced vasodilator with quick onset of action. Recently, however, nitroglycerin and other nitrates have partially replaced nitroprusside. This is because of three factors which limit the use of nitroprusside: 1. The drug is not effective orally. 2. It has a potent hypotensive effect and consequently requires careful monitoring. 3. Prolonged administration may result in thiocyanate toxicity.