Isoproterenol (injection): Difference between revisions

Isoproterenol (injection)
	Adult Indications & Dosage
	Pediatric Indications & Dosage
	Contraindications
	Warnings & Precautions
	Adverse Reactions
	Drug Interactions
	Use in Specific Populations
	Administration & Monitoring
	Overdosage
	Pharmacology
	Clinical Studies
	How Supplied
	Images
	Patient Counseling Information
	Precautions with Alcohol
	Brand Names
	Look-Alike Names

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Revision as of 13:57, 24 July 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gerald Chi

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Overview

Isoproterenol (injection) is a vasopressor that is FDA approved for the {{{indicationType}}} of heart block, Adams-Stokes attacks, cardiac arrest until electric shock or pacemaker therapy is available, bronchospasm occurring during anesthesia, and as an adjunct to fluid and electrolyte replacement therapy in hypovolemic and septic shock, low cardiac output (hypoperfusion) states, congestive heart failure, and cardiogenic shock. Common adverse reactions include syncope, tachyarrhythmia, confusion, headache, and tremor.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Isoproterenol hydrochloride injection is indicated:

For mild or transient episodes of heart block that do not require electric shock or pacemaker therapy.
For serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation).
For use in cardiac arrest until electric shock or pacemaker therapy, the treatments of choice, is available.

Start ISUPREL injection at the lowest recommended dose and increase the rate of administration gradually if necessary while carefully monitoring the patient. The usual route of administration is by intravenous infusion or bolus intravenous injection. In dire emergencies, the drug may be administered by intracardiac injection. If time is not of the utmost importance, initial therapy by intramuscular or subcutaneous injection is preferred.

There are no well-controlled studies in children to establish appropriate dosing; however, the American Heart Association recommends an initial infusion rate of 0.1 mcg/kg/min, with the usual range being 0.1 mcg/kg/min to 1 mcg/kg/min.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Such solution should not be used.

Heart Block, Adams-Stokes Attacks, and Cardiac Arrest

Dosing Information

File:Isoproterenol (injection)02.png

This image is provided by the National Library of Medicine.

Shock, Hypoperfusion States, and Bronchospasm Occurring During Anesthesia

Dosing Information

File:Isoproterenol (injection)03.png

This image is provided by the National Library of Medicine.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Acute Symptomatic Bradyarrhythmia

Developed by: ACC/AHA

Class of Recommendation: Class IIb

Strength of Evidence: Category C

Dosing Information

Isoproterenol is an alternative drug to dopamine or epinephrine, for the treatment of symptomatic bradycardia unresponsive to atropine.^[1]

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Isoproterenol (injection) in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Safety and efficacy of isoproterenol in pediatric patients have not been established.
Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0.05‑2.7 mcg/kg/min have caused clinical deterioration, myocardial necrosis, congestive heart failure and death. The risks of cardiac toxicity appear to be increased by some factors (acidosis, hypoxemia, coadministration of corticosteroids, coadministration of methylxanthines or aminophylline that are especially likely to be present in these patients. If I.V. isoproterenol is used in children with refractory asthma, patient monitoring must include continuous assessment of vital signs, frequent electrocardiography, and daily measurements of cardiac enzymes, including CPK-MB.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Isoproterenol (injection) in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Isoproterenol (injection) in pediatric patients.

Contraindications

Condition1

Warnings

Description

Precautions

Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Isoproterenol (injection) in the drug label.

Body as a Whole

Cardiovascular

Digestive

Endocrine

Hematologic and Lymphatic

Metabolic and Nutritional

Musculoskeletal

Neurologic

Respiratory

Skin and Hypersensitivy Reactions

Special Senses

Urogenital

Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Isoproterenol (injection) in the drug label.

Body as a Whole

Cardiovascular

Digestive

Endocrine

Hematologic and Lymphatic

Metabolic and Nutritional

Musculoskeletal

Neurologic

Respiratory

Skin and Hypersensitivy Reactions

Special Senses

Urogenital

Miscellaneous

Drug Interactions

Drug

Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

Pregnancy Category

Pregnancy Category (AUS):

Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Isoproterenol (injection) in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Isoproterenol (injection) during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Isoproterenol (injection) with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Isoproterenol (injection) with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Isoproterenol (injection) with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Isoproterenol (injection) with respect to specific gender populations.

Race

There is no FDA guidance on the use of Isoproterenol (injection) with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Isoproterenol (injection) in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Isoproterenol (injection) in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Isoproterenol (injection) in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Isoproterenol (injection) in patients who are immunocompromised.

Administration and Monitoring

Administration

Oral

Intravenous

Monitoring

There is limited information regarding Monitoring of Isoproterenol (injection) in the drug label.

Condition1

Description

IV Compatibility

There is limited information regarding IV Compatibility of Isoproterenol (injection) in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

Description

Management

Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Isoproterenol (injection) in the drug label.

Pharmacology



Isoproterenol (injection)
Systematic (IUPAC) name
(RS)-4-[1-hydroxy-2-(isopropylamino)ethyl]benzene-1,2-diol
Identifiers
CAS number	7683-59-2
ATC code	C01CA02 R03AB02 (WHO) R03CB01 (WHO)
PubChem	3779
DrugBank	DB01064
Chemical data
Formula	Template:OrganicBox atom Template:OrganicBox atom Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox atom Template:OrganicBox Template:OrganicBox atom Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox Template:OrganicBox
Mol. mass	211.258 g/mol
SMILES	eMolecules & PubChem
Pharmacokinetic data
Bioavailability	?
Metabolism	?
Half life	?
Excretion	?
Therapeutic considerations
Pregnancy cat.	C
Legal status	Template:Unicode Prescription only
Routes	inhaled 80-120μg

Mechanism of Action

Structure

File:Isoproterenol (injection)01.png

This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Isoproterenol (injection) in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Isoproterenol (injection) in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Isoproterenol (injection) in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Isoproterenol (injection) in the drug label.

Condition1

Description

How Supplied

Storage

There is limited information regarding Isoproterenol (injection) Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Isoproterenol (injection) |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Isoproterenol (injection) |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Isoproterenol (injection) in the drug label.

Precautions with Alcohol

Alcohol-Isoproterenol (injection) interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Isuprel®^[2]

Look-Alike Drug Names

N/A^[3]

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

↑ Neumar, Robert W. (2010-11-02). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): –729-767. doi:10.1161/CIRCULATIONAHA.110.970988. ISSN 1524-4539. PMID 20956224. Unknown parameter |coauthors= ignored (help)
↑ "ISUPREL (isoproterenol hydrochloride) injection, solution".
↑ "http://www.ismp.org". External link in |title= (help)

{{#subobject:

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[1] Neumar, Robert W. (2010-11-02). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): –729-767. doi:10.1161/CIRCULATIONAHA.110.970988. ISSN 1524-4539. PMID 20956224. Unknown parameter |coauthors= ignored (help)

[2] "ISUPREL (isoproterenol hydrochloride) injection, solution".

[www.ismp.org-3] "http://www.ismp.org". External link in |title= (help)

[1]

[2]

[3]

@@ Line 73: / Line 73: @@
 |offLabelAdultGuideSupport=
-=====Condition1=====
+=====Acute Symptomatic Bradyarrhythmia=====
-* Developed by:
+* Developed by:  ACC/AHA
-* Class of Recommendation:
+* Class of Recommendation: Class IIb
-* Strength of Evidence:
+* Strength of Evidence: Category C
 * Dosing Information
-:* Dosage
+* Isoproterenol is an alternative drug to [[dopamine]] or [[epinephrine]], for the treatment of symptomatic [[bradycardia]] unresponsive to [[atropine]].<ref>{{Cite journal | doi = 10.1161/CIRCULATIONAHA.110.970988 | issn = 1524-4539 | volume = 122 | issue = 18 Suppl 3 | pages = –729-767 | last = Neumar | first = Robert W. | coauthors = Charles W. Otto, Mark S. Link, Steven L. Kronick, Michael Shuster, Clifton W. Callaway, Peter J. Kudenchuk, Joseph P. Ornato, Bryan McNally, Scott M. Silvers, Rod S. Passman, Roger D. White, Erik P. Hess, Wanchun Tang, Daniel Davis, Elizabeth Sinz, Laurie J. Morrison | title = Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | date = 2010-11-02 | pmid = 20956224 }}</ref>
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@@ Line 109: / Line 97: @@
 |fdaLIADPed=
-=====Condition1=====
+* Safety and efficacy of isoproterenol in pediatric patients have not been established.
+* Intravenous infusions of isoproterenol in refractory asthmatic children at rates of 0.05‑2.7 mcg/kg/min have caused clinical deterioration, myocardial necrosis, congestive heart failure and death. The risks of cardiac toxicity appear to be increased by some factors (acidosis, hypoxemia, coadministration of corticosteroids, coadministration of methylxanthines or aminophylline that are especially likely to be present in these patients. If I.V. isoproterenol is used in children with refractory asthma, patient monitoring must include continuous assessment of vital signs, frequent electrocardiography, and daily measurements of cardiac enzymes, including CPK-MB.
-* Dosing Information
-:* Dosage
-=====Condition2=====
-There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
 <!--Off-Label Use and Dosage (Pediatric)-->
@@ Line 124: / Line 105: @@
 |offLabelPedGuideSupport=
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-* Developed by:
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-* Strength of Evidence:
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-:* Dosage
-=====Condition2=====
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@@ Line 144: / Line 111: @@
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-* Dosing Information
-:* Dosage
-=====Condition2=====
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