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Neonatal Intensive Care Drug Manual
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| bet | 329/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Isoprenaline
Revision Date : December 2019
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Approved: TC, KOH
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Alert
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Indication
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Temporary treatment of symptomatic bradyarrhythmia or heart block especially if caused by beta blocker overdose.
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Action
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Isoprenaline is a β1- and β2-adrenoceptor agonist. Its action on cardiac β1-adrenoceptors results in positive inotropic and chronotropic effects on the heart elevating blood pressure. Its action on arteriolar β2-adrenoceptors results in vasodilation and lowering of diastolic blood pressure. The overall effect is to decrease mean arterial pressure due to the β2-adrenoceptor mediated vasodilation. [1]
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Drug Type
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Catecholamine, β-adrenoceptor agonist drug
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Trade Name
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Isuprel Solution for injection
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Presentation
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Solution for injection 1:5000: 1 mg/5 mL ampoule = 200 microgram/1 mL.
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Dosage / Interval
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0.05–1 microgram/kg/minute. Doses may need to be many times higher in the management of beta blocker overdose. Consult with a clinical toxicologist (Poisons Information Centre 131126).
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Maximum daily dose
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2 microgram/kg/minute. Doses may need to be many times higher in the management of beta blocker overdose. Consult with a clinical toxicologist (Poisons Information Centre 131126).
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Route
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Continuous IV infusion.
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Preparation/Dilution
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Isoprenaline hydrochloride (1:5000)*
LOW concentration IV infusion
Infusion strength
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Prescribed amount
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1 mL/hour = 0.05 microgram/kg/minute
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150 microgram/kg isoprenaline and make up to 50 mL
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Draw up 150 microgram/kg [0.75 mL/kg] of 1:5000 isoprenaline and add glucose 5% or sodium chloride 0.9% to make a final volume of 50 mL. Infusing at a rate of 1 mL/hour = 0.05 microgram/kg/minute.
HIGH concentration IV infusion (can be used for infants up to 2.2 Kg)
Infusion strength
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Prescribed amount
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1 mL/hour = 0.5 microgram/kg/minute
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1500 microgram/kg isoprenaline and make up to 50 mL
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Draw up 1500 microgram/kg [7.5 mL/kg] of 1:5000 isoprenaline and add glucose 5% or sodium chloride 0.9% to make a final volume of 50 mL. Infusing at a rate of 1 mL/hour = 0.5 microgram/kg/minute.
*Maximum reported concentration of the infusion preparation is 64 microgram/mL.
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Administration
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Continuous intravenous infusion. Change infusion every 24 hours.
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Monitoring
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Continuous heart rate, ECG and blood pressure monitoring preferable.
Assess urine output and peripheral perfusion frequently.
Blood glucose.
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Contraindications
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Tachyarrhythmias; tachycardia or heart block caused by digitalis intoxication; ventricular arrhythmias which require inotropic therapy; coronary insufficiency; hypersensitivity to isoprenaline.
Isoprenaline should not be given simultaneously with adrenaline because their combined effects may induce serious arrhythmia.
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Precautions
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Isoprenaline infusion may produce an increase in myocardial work and oxygen consumption.
Titrate drug dose to heart rate.
Correct acidosis prior to commencement.
Ensure adequate circulating blood volume prior to commencement. As isoprenaline is a vasodilator, additional volume expansion may be required during infusion.
Monitor for hypoglycaemia – stimulates insulin secretion.
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Drug Interactions
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Inhalational anaesthetics can increase the effects of isoprenaline.
Use of isoprenaline hydrochloride in conjunction with aminophylline and corticosteroids may be additive in cardiotoxic properties.
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Adverse Reactions
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Tachycardia.
Cardiac arrhythmias.
Systemic vasodilation and hypotension.
Hypoglycaemia.
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Compatibility
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Fluids: Glucose 5%; sodium chloride 0.9%.
Y-site: Aciclovir, adrenaline (epinephrine), amikacin, amiodarone, amphotericin B liposomal, atracurium, atropine, azithromycin, aztreonam, benzylpenicillin, caffeine citrate, calcium chloride, calcium gluconate, cefazolin, cefotaxime, ceftazidime, ceftriaxone, chloramphenicol, clindamycin, dexamethasone, digoxin, dobutamine, dopamine, fentanyl, fluconazole, gentamicin, heparin, hydrocortisone, lignocaine, metronidazole, milrinone, morphine, nitroprusside, nitroglycerin, noradrenaline (norepinephrine), pancuronium, penicillin, piperacillin(-tazobactam), potassium chloride, propofol, ranitidine, remifentanil, ticarcillin, vasopressin, vitamin K.
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Incompatibility
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Aminophylline, ampicillin sodium, amphotericin B conventional colloidal, amphotericin B lipid complex, diazepam, diazoxide, frusemide, ganciclovir, hydralazine, ibuprofen, indomethacin, insulin, pentobarbitone (pentobarbital), phenytoin, sodium bicarbonate, sulfamethoxazole-trimethoprim.
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Stability
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Do not administer if the solution is pinkish or darker than slightly yellow or if a precipitate is present. Change the infusion every 24 hours.
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Storage
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Store below 25°C. Protect from light.
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Special Comments
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Evidence summary
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Efficacy:
The efficacy and dosing of isoprenaline in newborns has only been assessed in case reports.
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