Isoproterenol

• Isoproterenol

• Isuprel

Classification:

• Sympathetic agonist

Mechanism of Action:

• Synthetic catecholamine
• Acts primarily on beta-adrenergic receptors
• No significant alpha-receptor stimulating capabilities
• Primarily acts on the heart and lungs
• In cardiac emergencies maybe used to increase heart rate in bradycardias that are refractory to atropine

Indications:

• Treatment of hemodynamically significant bradycardia in denervated transplanted heart patients
• Treatment of hemodynamically significant bradycardia refractory to pacing, atropine, dopamine, and  epinephrine
• Beta blocker overdose

Contraindications:

• Not used to increase blood pressure in cardiogenic shock
• Other sympathomimetics, such as dopamine and norepinephrine, should be used

Precautions:

• Hepatic or renal insufficiency
• AV node dysfunction
• Coronary artery disease, cardiogenic shock, D/C if signs of ischemia worsen
• May exacerbate tachy dysrhythmias due to digitalis toxicity and precipitate hypokalemia

Adverse Effects:

• Nervousness
• Headache
• Tremor
• Dysrhythmias
• Hypertension
• Angina
• Nausea and vomiting 

Dose:

• 1 mg diluted in 500 ml of D5W (2 mcg/ml)
  • Titrate until the desired heart rate is attained or until signs of ventricular irritability
  • Recommended infusion rate is 2 – 10 mcg/min

• IV

• Compendium of Pharmaceuticals and Specialties (CPS)