isoproterenol (Rx)

Brand and Other Names:Isuprel
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

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

Dosage Forms & Strengths

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  

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Interactions

Interaction Checker

and isoproterenol

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Tachycardia

            Hypertension

            Dysrhythmias

            Angina

            Dizziness

            Nervousness

            Restlessness

            Hypokalemia

            MI size increased

            Syncope

            Confusion

            Headache

            Tremor

            Nausea

            Vomiting

            Weakness,

            Tremor

            Dyspnea

            Pulmonary edema

            Diaphoresis

            Blurred vision

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            Warnings

            Contraindications

            Hypersensitivity, digitalis intoxication, angina pectoris, preexisting cardiac arrhythmias (particularly ventricular arrythmias that require inotropic treatment & tachyarrhythmias)

            No longer recommended for cardiac arrest

            Cautions

            Use caution in patients with convulsive disorders, renal disease, CAD, coronary insufficiency, DM, HTN, hyperthyroidism, hyperresponsiveness to sympathomimetic amines, elderly

            Questionable efficacy for shock

            May cause thyroid storm in susceptible patients with hyperthyroidism

            May transiently increase blood glucose levels

            Not currently treatment of choice

            Anesthesia due to cyclopropane or halogenated hydrocarbons

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            Pregnancy & 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.

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            Pharmacology

            Mechanism of Action

            Strong beta-1 & beta-2 effects resulting in relaxation of GI, bronchial, and uterine smooth muscle; may increase vasodilation of peripheral vasculature, and heart rate and contractility

            Pharmacokinetics

            Half-Life: 2.5-5 min

            Duration: 10-15 min (IV)

            Metabolism: Primarily in liver & lung by monoamine oxidase (MAO) & catechol-O-methyl transferase (COMT)

            Metabolites: 3-O-methyl-isoproterenol (inactive)

            Excretion: Urine (50-80%)

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            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

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.