Dosing and uses of Isuprel (isoproterenol)
Adult dosage forms and strengths
aerosoL
- 0.131mg/inh
injectable solution
- 0.2mg/mL
Adams-Stokes Attacks, Cardiac Arrest, or Heart Block
IV bolus: 0.02-0.06 mg (1-3 mL of a 1:50,000 dilution), initially, THEN doses of 0.01-0.2 mg
IV infusion: 5 mcg/min (1.25 mL of a 1:250,000 dilution), initially, THEN doses of 2-20 mcg/min based on patient's response
Shock
0.5-5 mcg/min (0.25-2.5 mL of a 1:250,000 dilution) IV infusion
Bronchospasm During Anesthesia
0.01-0.02 mg IV repeat PRn
Other Indications & Uses
Ventricular arrhythmias due to AV block, shock, Adams-Stokes, bronchospasm
Pediatric dosage forms and strengths
aerosoL
- 0.131mg/inh
injectable solution
- 0.2mg/mL
Adams-Stokes Attacks (Off-label)
Initial: 0.1 mcg/kg/min IV infusion
Usual dose: 0.1-1 mcg/kg/min IV infusion
Cardiac Arrest (Off-label)
Initial: 0.1 mcg/kg/min IV infusion
Usual dose: 0.2 to 1 mcg/kg/min
Heart Block (Off-label)
Initial: 0.1 mcg/kg/min IV infusion
Usual dose: 0.3 to 1 mcg/kg/min IV infusion
Postoperative Cardiac Patients with Bradycardia
IV infusion: 0.029 mcg/kg/min
Isuprel (isoproterenol) adverse (side) effects
Frequency not defined
Tachycardia
Hypertension
Dysrhythmias
Angina
MI size increased
Syncope
Confusion
Headache
Tremor
Warnings
Contraindications
Hypersensitivity, digitalis intoxication, angina pectoris, preexisting cardiac arrhythmias (particularly ventr arrythmias that require inotropic Tx & tachyarrhythmias)
No longer recommended for cardiac arrest
Cautions
Convulsive disorders, renal disease, CAD, coronary insufficiency, DM, HTN, hyperthyroidism, hyperresponsiveness to sympathomimetic amines, elderly
Questionable efficacy for shock
Not currently Tx of choice
Anesthesia due to cyclopropane or halogenated hydrocarbons
Pregnancy and lactation
Pregnancy category: C
Lactation: not known if excreted into breast milk, avoid
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Isuprel (isoproterenol)
Half-Life: 3-7 hr
Duration: cardiac arrest (IV): 8-50 min
Metabolism: primarily in liver & lung by monoamine oxidase (MAO) & catechol-O-methyl transferase (COMT)
Metabolites: 3-O-methyl-isoproterenol (inactive)
Excretion: urine: 50-80%
Mechanism of action
Strong beta-1 & beta-2 effects resulting in incr CO, decr PVR, & variable BP & renal perfusion changes
Administration
IV Incompatibilities
Solution Na-bicarb 5%
Additive: aminophylline, furosemide, NaHCO3
IV Compatibilities
Solution (partial list): D5W, D10W, dextrose-saline, dextrose/LR, NS, ½NS, LR, Ringer's
Additive: atracurium, CaCl2, cimetidine, dobutamine, floxacillin, heparin, MgSO4, KCl, ranitidine, succinylcholine, verapamil, vit B/C
Syringe: ranitidine, caffeine
Y-site: amiodarone, atracurium, bivalirudin, cisatracurium, dexmetedomidine, epinephrine, famotidine, fenoldopam, heparin, hydrocortisone, Hextend, inamrinone, KCl, levofloxacin, milrinone, pancuronium, propofol, remifentanil, Na-nitroprusside, tacrolimus, vecuronium, vit B/C
IV/IM Administration
Adminster by IV infusion (requires infusion pump), or
By direct IV, IM, or SC injection
In extreme emergencies, by intracardiac injection
IV Preparation
1 mg (5 mL) in 500 mL D5W (2 mcg/mL) for IV infusion
Storage
Store in a cool place between 2-15°C
Protect from light
