IV (Adults ): 0.5 ng/kg/min initially as continuous infusion (based on actual body weight); then titrate by 0.5 ng/kg/min every 30 min based on tolerability up to 2 ng/kg/min. Continue infusion for 6 hr each day for up to a maximum of 8 consecutive days. Repeat dosage titration steps on Days 2 and 3; from Day 4 and thereafter, start at highest tolerated infusion rate from previous day and adjust, if needed, based on tolerability.
Renal Impairment
IV (Adults ): CCr <30 mL/min: 0.25–0.5 ng/kg/min initially as continuous infusion (based on actual body weight); then titrate by 0.5 ng/kg/min every 30 min based on tolerability up to 2 ng/kg/min. Continue infusion for 6 hr each day for up to a maximum of 8 consecutive days. Repeat dosage titration steps on Days 2 and 3; from Day 4 and thereafter, start at highest tolerated infusion rate from previous day and adjust, if needed, based on tolerability. Hemodialysis: Start administration of infusion at the end of hemodialysis session or start hemodialysis ≥1 hr after end of infusion.
Hepatic Impairment
IV (Adults ): Moderate or severe hepatic impairment: 0.25 ng/kg/min initially as continuous infusion (based on actual body weight); then titrate by 0.5 ng/kg/min every 30 min based on tolerability up to 2 ng/kg/min. Continue infusion for 6 hr each day for up to a maximum of 8 consecutive days. Repeat dosage titration steps on Days 2 and 3; from Day 4 and thereafter, start at highest tolerated infusion rate from previous day and adjust, if needed, based on tolerability.
Availability⬆⬇
Solution for injection: 100 mcg/mL
Assessment⬆⬇
Monitor vital signs prior to start of infusion and after every ↑ in dose. Correct hypotension before starting infusion. If hypotension persists despite discontinuation of other vasodilators or administration of fluids, consider ↓ dose or discontinuing therapy.
Implementation⬆⬇
IV Administration:
Continuous Infusion: Diluent: Withdraw 1 mL (100 mcg) from vial and add to infusion bag containing 100 mL of 0.9% NaCl; do not use any other type of diluent.Concentration: 1 mcg/mL.Gently invert bag to mix; do not shake. Use diluted solution immediately; may be stored at room temperature for up to 4 hr; then discard.
Rate: Infuse through a peripheral line or peripherally inserted central catheter using an infusion pump. Infuse through a 0.2 or 0.22 micron in-line filter. Do not administer as IV push or bolus. Administer continuous IV infusion over 6 hr each day for up to a maximum of 8 consecutive days.
Y-Site Incompatibility: Do not administer other drugs through same IV line.
If adverse reactions occur that cannot be tolerated by the patient, ↓ dose by 0.5 ng/kg/min every 30 min until a tolerated dose is achieved. If an adverse reaction occurs at the starting dose of the infusion, discontinue the infusion; infusion can be restarted after the adverse reaction has resolved or been treated. If infusion is stopped at any point for an adverse reaction, infusion can be reinitiated at a previously tolerated dose once the event has resolved. The maximum tolerated dose should be maintained for the remaining 6-hr daily infusion.
Patient/Family Teaching⬆⬇
May cause dizziness and fainting due to hypotension. Caution patient to change positions slowly to minimize orthostatic hypotension.
Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.
Evaluation/Desired Outcomes⬆⬇
Reduction in risk of digit amputation due to frostbite.
