Adult Dosing
Heart block, Stokes-Adams attacks, and cardiac arrest
- Bolus IV
- Initial dose: 0.02-0.06 mg (1-3 mL) IV bolus
- Subsequent dose: 0.01-0.2 mg (0.5-10 mL)
- IV infusion
- Initial dose: 5 mcg/min (1.25 mL/minute) IV
- IM
- Initial dose: 0.2 mg (1mL) IM
- Subsequent dose: 0.02-1 mg or 0.1-5 mL IM
- SC
- Initial dose: 0.2 mg (1 mL) SC
- Subsequent dose: 0.15-0.2 mg (0.75-1 mL)
- Intracardiac
- Initial dose: 0.02 mg (0.1 mL)
Shock and hypoperfusion states
- 0.5-5 mcg/minute (0.25-2.5 mL) IV infusion
Bronchospasm occurring during anesthesia
- Initial dose: 0.01-0.02 mg (0.5-1 mL) bolus IV
- Subsequent dose: Repeat the initial dose as needed
Notes:- Adjust the rate of infusion on the basis of heart rate, central venous pressure, systemic blood pressure, and urine flow
- If the heart rate >110 beats/minute; reduce the rate of infusion or temporarily discontinue the infusion
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Isoproterenol may cause a deleterious effect on the injured or failing heart by increasing myocardial oxygen requirements while decreasing effective coronary perfusion. Do not use as the initial agent in treating cardiogenic shock following myocardial infarction
- Therapy may produce beneficial hemodynamic and metabolic effects, when a low arterial pressure has been elevated by other means
- In certain patients with organic disease of the AV node and its branches, isoproterenol has been reported to worsen heart block or to precipitate Stokes-Adams attacks during normal sinus rhythm or transient heart block
- Contraindicated in patients hypersensitive to sulfites because it may cause allergic-type reactions such as anaphylactic symptoms and life-threatening or less severe asthmatic episodes in this susceptible population
- Start with the lower recommended dose and may gradually increase the dose to a sufficient level while carefully monitoring the patient's heart rate as it should not exceed beyond 130 beats/minute
- In most cases of shock, filling of the intravascular compartment adequately by suitable volume expanders is of primary importance and should precede the administration of vasoactive drugs
- Routinely monitor systemic blood pressure, heart rate, urine flow, the electrocardiograph, and therapy response by frequent determination of the central venous pressure and blood gases
- If heart rate is >110 beats/minute, decrease the infusion rate or temporarily discontinue the infusion; carefully monitor patients in shock during therapy
- Determine cardiac output and circulation time during therapy; check acid-base balance and rectify electrolyte disturbances if any
- Institute appropriate antimicrobial therapy in cases of shock associated with bacteremia
Cautions: Use cautiously in
- Coronary artery disease
- Coronary insufficiency
- Diabetes
- Hyperthyroidism
- Sensitivity to sympathomimetic amines
- Hypokalemia
- Renal impairment
- Elderly patients
Pregnancy Category:C
Breastfeeding: Manufacturer advises caution.
