"The US Food and Drug Administration (FDA) has received multiple adverse event reports associated with the use of the Vascu-Guard Peripheral Vascular Patch (Baxter International Inc) during carotid endarterectomy (CEA).
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). (See CONTRAINDICATIONS.)
- For use in cardiac arrest until electric shock or pacemaker therapy, the treatments of choice, is available. (See CONTRAINDICATIONS.)
- For bronchospasm occurring during anesthesia.
- As an adjunct to fluid and electrolyte replacement therapy and the use of other drugs and procedures in the treatment of hypovolemic and septic shock, low cardiac output (hypoperfusion) states, congestive heart failure, and cardiogenic shock. (See WARNINGS.)
DOSAGE AND ADMINISTRATION
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.
Recommended dosage for adults with heart block, Adams-Stokes
attacks, and cardiac arrest:
|Route of Administration||Preparation of Dilution||Initial Dose||Subsequent Dose Range*|
|Bolus intravenous injection||Dilute 1 mL (0.2 mg) in 9 mL of Sodium Chloride Injection, USP, or 5% Dextrose Injection, USP||0.02 mg to 0.06 mg (1 mL to 3 mL of diluted solution)||0.01 mg to 0.2 mg (0.5 mL to 10 mL of diluted solution)|
|Intravenous infusion||Dilute 10 mL (2 mg) in 500 mL of 5% Dextrose Injection, USP||5 mcg/min. (1.25 mL of diluted solution per minute)|
|Intramuscular||Use Solution undiluted||0.2 mg (1 mL)||0.02 mg to 1 mg (0.1 mL to 5 mL)|
|Subcutaneous||Use Solution undiluted||0.2 mg (1 mL)||0.15 mg to 0.2 mg (0.75 mL to 1 mL)|
|Intracardiac||Use Solution undiluted||0.02 mg (0.1 mL)|
|* Subsequent dosage and method of administration depend on the ventricular rate and the rapidity with which the cardiac pacemaker can take over when the drug is gradually withdrawn.|
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.
Recommended dosage for adults with shock and
|Route of Administration||Preparation of Dilution†||Infusion Rate†,†|
|Intravenous infusion||Dilute 5 mL (1 mg) in 500 mL of 5% Dextrose Injection, USP||0.5 mcg to 5 mcg per minute (0.25 mL to 2.5 mL of diluted solution)|
|† Concentrations up to 10 times greater have been used
when limitation of volume is essential.
†† Rates over 30 mcg per minute have been used in advanced stages of shock. The rate of infusion should be adjusted on the basis of heart rate, central venous pressure, systemic blood pressure, and urine flow. If the heart rate exceeds 110 beats per minute, it may be advisable to decrease or temporarily discontinue the infusion.
Recommended dosage for adults with bronchospasm
occurring during anesthesia:
|Route of Administration||Preparation of Dilution||Initial Dose||Subsequent Dose|
|Bolus intravenous injection||Dilute 1 mL (0.2 mg) in 9 mL of Sodium Chloride Injection, USP, or 5% Dextrose Injection, USP||0.01 mg to 0.02 mg (0.5 mL to 1 mL of diluted solution)||The initial dose may be repeated when necessary|
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.
|0409-1442-02||Ampul||0.2 mg/mL||1 mL||UNI-AMP™ pak of 25|
|0409-1442-03||Ampul||1 mg/5 mL (0.2 mg/mL)||5 mL||10 ampuls per carton|
Protect from light. Keep in opaque container until used.
Store at 20° to 25°C (68° to 77°F). [See USP Controlled Room Temperature.]
Do not use if the injection is pinkish or darker than slightly yellow or contains a precipitate.
Hospira, Inc., Lake Forest, IL 60045 USA. Revised: 03/2013.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 1/31/2017
Additional Isuprel Information
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