Neonatal Intensive Care Drug Manual

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1 mL/hour = 0.05 microgram/kg/minute.
1 mL/hour = 0.5 microgram/kg/minute.

Isoprenaline

Revision Date : December 2019

Approved: TC, KOH

Alert

Indication

Temporary treatment of symptomatic bradyarrhythmia or heart block especially if caused by beta blocker overdose.

Action

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]

Drug Type

Catecholamine, β-adrenoceptor agonist drug

Trade Name

Isuprel Solution for injection

Presentation

Solution for injection 1:5000: 1 mg/5 mL ampoule = 200 microgram/1 mL.

Dosage / Interval

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).

Maximum daily dose

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).

Route

Continuous IV infusion.

Preparation/Dilution

Isoprenaline hydrochloride (1:5000)*

LOW concentration IV infusion

Infusion strength	Prescribed amount
1 mL/hour = 0.05 microgram/kg/minute	150 microgram/kg isoprenaline and make up to 50 mL

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	Prescribed amount
1 mL/hour = 0.5 microgram/kg/minute	1500 microgram/kg isoprenaline and make up to 50 mL

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.

Administration

Continuous intravenous infusion. Change infusion every 24 hours.

Monitoring

Continuous heart rate, ECG and blood pressure monitoring preferable.
Assess urine output and peripheral perfusion frequently.

Blood glucose.

Contraindications

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.

Precautions

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.

Drug Interactions

Inhalational anaesthetics can increase the effects of isoprenaline.

Use of isoprenaline hydrochloride in conjunction with aminophylline and corticosteroids may be additive in cardiotoxic properties.

Adverse Reactions

Tachycardia.

Cardiac arrhythmias.

Systemic vasodilation and hypotension.

Hypoglycaemia.

Compatibility

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.

Incompatibility

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.

Stability

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.

Storage

Store below 25°C. Protect from light.

Special Comments

Evidence summary

Efficacy:

The efficacy and dosing of isoprenaline in newborns has only been assessed in case reports.

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