Isoprenaline


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Bronchospasm during anaesthesia Initial: 0.01-0.02 mg (0.5-1 mL) via bolus inj, may repeat dose if necessary. Cardiac arrest; Heart block; Stokes-Adams attacks Initial: 0.02-0.06 mg (1-3 mL of a 1:50,000 dilution), followed by 0.01-0.2 mg (0.5-10 mL) via bolus inj. Alternatively, initially, 5 mcg/min (1.25 mL of a 1:250,000 dilution) via infusion. Adjunct to shock 0.5-5 mcg/min (0.25-2.5 mL of dilution) via infusion, adjust rate according to response. IM Cardiac arrest; Heart block; Stokes-Adams attacks Initial: 0.2 mg (1 mL), followed by subsequent dose of 0.02-1 mg (0.1-5 mL). SC Cardiac arrest; Heart block; Stokes-Adams attacks Initial: 0.2 mg (1 mL), followed by subsequent dose of 0.15-0.2 mg (0.75-1 mL). Intracardiac Cardiac arrest; Heart block; Stokes-Adams attacks Initial: 0.02 mg (0.1 mL).
Dosage Details
Intracardiac
Cardiac arrest, Heart block, Stokes-Adams attacks
Adult: Initially, 0.02 mg (0.1 mL).

Intramuscular
Cardiac arrest, Heart block, Stokes-Adams attacks
Adult: Initially, 0.2 mg (1 mL), followed by subsequent dose of 0.02-1 mg (0.1-5 mL). Subsequent dosage and method of administration depends on the ventricular rate and rapidity with which cardiac pacemaker can take over when the medicine is gradually withdrawn.

Intravenous
Adjunct in shock
Adult: 0.5-5 mcg per minute (0.25-2.5 mL of dilution) given via infusion, adjust rate according to patient response.

Intravenous
Cardiac arrest, Heart block, Stokes-Adams attacks
Adult: Initially, 0.02-0.06 mg (1-3 mL of a 1:50,000 dilution), followed by 0.01-0.2 mg (0.5-10 mL) given via bolus inj. Subsequent dosage and method of administration depends on the ventricular rate and rapidity with which cardiac pacemaker can take over when the medicine is gradually withdrawn. Alternatively, initially, 5 mcg per minute (1.25 mL of a 1:250,000 dilution) given via infusion.

Intravenous
Bronchospasm during anaesthesia
Adult: Initially, 0.01-0.02 mg (0.5-1 mL) via bolus inj, may repeat dose if necessary.

Subcutaneous
Cardiac arrest, Heart block, Stokes-Adams attacks
Adult: Initially, 0.2 mg (1 mL), followed by subsequent dose of 0.15-0.2 mg (0.75-1 mL). Subsequent dosage and method of administration depends on the ventricular rate and rapidity with which cardiac pacemaker can take over when the medicine is gradually withdrawn.
Reconstitution
IV bolus: Dilute 1 mL of solution labelled as containing 1:5000 solution with 10mL NaCl inj or dextrose 5% inj to make a 1:50,000 solution. IV infusion for heart block; Stokes-Adams attacks; cardiac arrest: Dilute 10 mL of solution labelled as containing 1:5000 solution with 500 mL dextrose 5% inj to make a 1:250,000 solution. IV infusion for shock: Dilute 5 mL of solution labelled as containing 1:5000 solution with 500 mL dextrose 5% inj.
Contraindications
Angina pectoris; ventricular arrhythmias requiring inotropic therapy; tachyarrhythmias; recent MI; tachycardia; heart block due to cardiac glycoside intoxication.
Special Precautions
Patient with CV disease (e.g. coronary artery disease, ischaemic heart disease), hypertension, diabetes mellitus, distributive shock, hyperthyroidism, aneurysms. May exacerbate Adams-Stokes seizures during normal sinus rhythm or transient heart block. Ensure adequate ventilation. Renal and hepatic impairment. Elderly. Pregnancy and lactation.
Adverse Reactions
Cardiac disorders: Tachycardia, palpitations, angina, Stokes-Adams attacks, hypertension, hypotension, ventricular arrhythmias, tachyarrhythmias, pulmonary oedema, dyspnoea.
Gastrointestinal disorders: Nausea, vomiting.
General disorders and administration site conditions: Sweating, warmth, weakness.
Eye disorders: Blurring of vision.
Investigations: Increased serum glucose.
Metabolism and nutrition disorders: Hypokalaemia.
Nervous system disorders: Nervousness, headache, dizziness, restlessness, tension, fear of excitement, tremors.
Vascular disorders: Flushing, pallor.
Potentially Fatal: Cardiac dysrhythmia and myocardial necrosis.
IM/Inhalation/Respiratory/Intracardiac/IV/Parenteral/PO/SC: C
Patient Counseling Information
This drug may cause dizziness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor blood pressure, heart rate, urine flow, ECG, central venous pressure, blood gases. Monitor acid-base balance and correct any electrolyte disturbances.
Overdosage
Symptoms: Tachycardia or other arrhythmias, palpitations, angina, hypotension or hypertension. Management: Supportive and symptomatic treatment. Reduce rate of administration or discontinue isoprenaline. Monitor blood pressure, pulse, respiration, ECG.
Drug Interactions
Enhanced arrhythmogenic effect with inhalational anaesthetics (e.g. halothane and cyclopropane). Antagonistic effects with ß-adrenergic blocking agents (e.g. propranolol, atenolol). Increased risk of cardiac arrhythmias with levodopa. May reduce antianginal effects of nitrates. Magnified effect with MAOIs and chlorpromazine.
Potentially Fatal: Severe arrhythmias with epinephrine and digitalis. Additive cardiotoxic properties and potential myocardial necrosis with IV methyl xanthines (e.g. aminophylline and theophylline) and IV corticosteroids.
Action
Description: Isoprenaline is a potent and nonselective ß-adrenergic agonist. It increases heart rate and contractility by its positive inotropic and chronotropic actions. It also relaxes bronchial, gastrointestinal, and uterine smooth muscles.
Synonym: Isoproterenol.
Onset: Immediate (IV).
Duration: 10-15 minutes (IV).
Pharmacokinetics:
Metabolism: Metabolised in the liver, lungs and other tissues by COMT to major metabolite, 3-O-methylisoprenaline.
Excretion: Via urine primarily as sulfate conjugates. Elimination half-life: 2 hours (SC); 2.5-5 minutes (IV).
Chemical Structure

Chemical Structure Image
Isoprenaline

Source: National Center for Biotechnology Information. PubChem Database. Isoprenaline, CID=3779, https://pubchem.ncbi.nlm.nih.gov/compound/Isoprenaline (accessed on Jan. 21, 2020)

Storage
Store below 25°C. Protect from light.
ATC Classification
R03CB01 - isoprenaline ; Belongs to the class of adrenergics for systemic use, non-selective beta-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
C01CA02 - isoprenaline ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
References
Anon. Isoproterenol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 21/03/2019.

Buckingham R (ed). Isoprenaline. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 21/03/2019.

Isoproterenol Hydrochloride Injection, Solution (Cipla USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 21/03/2019.

Pfizer New Zealand Limited. Isuprel Injection data sheet 22 August 2017. Medsafe. http://www.medsafe.govt.nz/. Accessed 21/03/2019.

Disclaimer: This information is independently developed by MIMS based on Isoprenaline from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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