Isoproterenol
ISUPREL
What it isNon-selective beta agonist; bradyarrhythmia, heart block and torsades.
Why this onePure beta agonism raises rate and contractility without alpha vasoconstriction, so it is used as a chemical pacemaker.
What limits itTachyarrhythmia and myocardial ischemia from raised oxygen demand. Hypotension from beta-2 vasodilation.
FDA-approved for
- bradyarrhythmias / heart block (1956)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Shock and hypoperfusion states | Adult | 0.5 mcg/min IV infusion | 0.5-5 mcg/min IV infusion (titrate) | >30 mcg/min used in advanced shock |
| Bronchospasm during anesthesia | Adult | 10-20 mcg IV bolus | 10-20 mcg IV bolus PRN | |
| Infusion (AHA, safety not established) | Pediatric | 0.1 mcg/kg/min | 0.1-1 mcg/kg/min IV infusion |
Renal Undefined
Hepatic Undefined
Bronchospasm bolus (10-20 mcg) may be repeated when necessary.
Instructions
- IV use; start at the lowest dose and titrate to response
- Adjust infusion by heart rate, CVP, blood pressure and urine flow; reduce or briefly stop if HR >110 bpm
- Inspect for particulate matter/discoloration; do not use if pinkish, darker than slightly yellow, or containing precipitate
Contraindications
- Tachycardia
- Ventricular arrhythmias
- Angina pectoris
Cautions
- May induce cardiac arrhythmias and myocardial ischemia, esp. with coronary artery disease or cardiomyopathy
Adverse reactions
- Tachycardia, palpitations, tachyarrhythmias, angina
- Nervousness, headache, dizziness
- Flushing, sweating, tremor, nausea
- Dyspnea; pulmonary edema (rare)
Pregnancy Decades of use show no drug-associated birth-defect risk; avoid during 2nd stage of labor and when maternal BP >130/80.
Lactation No data; low infant exposure expected given short half-life.
NO BOXED WARNINGS
Principal riskTachyarrhythmia and myocardial ischemia
Classes and tags
Clinical profile
Mechanism of action: Isoproterenol ballicule
