Isoprenaline

Indications
 Intravenous
Bronchospasm during anaesthesia
Adult: 0.01-0.02 mg (0.5-1 ml of a 1:50,000 dilution), repeat when necessary.
Elderly: Lower doses may be required.
Intravenous
Emergency treatment of cardiac arrhythmias
Adult: IV bolus inj: Initially, 0.02-0.06 mg (1-3 ml of a 1:50,000 dilution). Subsequent dose range: 0.01-0.2 mg. IV infusion: Initially, 5 mcg/minute. Adjust subsequent doses based on patient's response; usual range: 2-20 mcg/minute.
Child: Initially, 0.1 mcg/kg/minute. Subsequent dose range: 0.1-1 mcg/kg/minute.
Parenteral
Postoperative cardiac patients with bradycardia
Adult: For less urgent situations. Initial: 0.2 mg via IM or SC admin. Subsequent dose ranges: 0.02-1 mg (via IM admin) or 0.15-0.2 mg (via SC admin).
Child: 0.029 mcg/kg/minute via IV infusion.
Intravenous
For temporary use in 3rd degree atrioventricular block until pacemaker insertion
Adult: 2-10 mcg/minute via IV infusion. Adjust subsequent rate based on patient's heart rate and rhythm response.
Intravenous
Complete heart block following closure of ventricular septal defects
Adult: 0.04-0.06 mg (2-3 mL of a 1:50,000 dilution) as bolus doses.
Child: Infants: 0.01-0.03 mg (0.5-1.5 mL of a 1:50,000 dilution) as bolus dose.
Intravenous
Adjunct in shock
Adult: 0.5-5 mcg/minute, adjust subsequent rate based on patient's response. In advanced stages: rates >30 mcg/minute have been used. Not recommended for >1 hr usage in patients with septic shock.
Intravenous
As a diagnostic agent
Adult: For diagnosing etiology of mitral regurgitation: 4 mcg/minute as infusion. For diagnosis of coronary artery disease or lesions: 1-3 mcg/minute as infusion.

Reconstitution: Reconstitute with supplied diluent only.
Contraindications
 Tachyarrhythmias; tachycardia or heart block due to digitalis intoxication; ventricular arrhythmias which require inotropic therapy; angina pectoris.
Warnings / Precautions
 Coronary artery disease, coronary insufficiency, diabetes, hyperthyroidism. Pregnancy and lactation. Parenteral: May paradoxically worsen heart block or precipitate Adams-Stokes attacks during normal sinus rhythm or transient heart block. Doses which can increase heart rate to >130 beats/min may increase the risk of inducing ventricular arrhythmias; caution in patients with failing heart or in those with significant degree of arteriosclerosis. Monitor response to therapy by frequent determination of the central venous pressure and blood gases. Ensure adequate ventilation. Monitor acid-base balance and correct any electrolyte disturbances. Inhalation: Severe paradoxical airway resistance may occur with repeated and excessive use. Carefully instruct the patient in the proper technique of admin.
Adverse Reactions
 Nervousness, restlessness, insomnia, anxiety, tension, blurring of vision, fear, excitement. Rarely, sweating, weakness, pallor, dizziness, mild tremor, headache, flushing of the face or skin, nausea, vomiting, tinnitus, lightheadedness, asthenia. Swelling of the parotid glands (prolonged use). Pulmonary oedema, dyspneoa. Palpitation and ventricular tachycardia. Transient myocardial ischaemia or myocardial dysfunction in children.
Potentially Fatal: Ventricular arrhythmias.
Overdose Reactions
 Symptoms: Tachycardia or other arrhythmias, palpitations, angina, BP changes, dizziness, headache, nausea or vomiting, restlessness, weakness, flushing. Management: Supportive and symptomatic; monitor BP and ECG. Not known if dialysable.
Drug Interactions
 Additive peripheral vasoconstriction may occur with ergot alkaloids. Cardiac, bronchodilating and vasodilating effects may be antagonised by β-blockers e.g. propranolol.
Potentially Fatal: IV: Severe arrhythmias may occur with epinephrine, digitalis, cyclopropane, halogenated hydrocarbon anaesthetics.
See Below for More isoprenaline Drug Interactions
Lab Interactions
 May cause false elevations of bilirubin as measured in vitro by a sequential multiple analyser. May produce elevated values for urinary epinephrine.
Mechanism of Actions
 Isoprenaline is a sympathomimetic that acts directly on β-adrenergic receptors. It stimulates the CNS, has powerful stimulating action on the heart, and has bronchodilating properties.
Duration: Inhalation: About 2 hr.
Absorption: Less active after oral admin than after parenteral admin due to sulfate conjugation in the gut. Also absorbed through the oral mucosa.
Metabolism: Resistant to metabolism by monoamine oxidase. Metabolised by catechol-O-methyltransferase in the liver, lungs, and other tissues.
Excretion: Via urine (as unchanged drug and metabolites). Plasma half-life: IV: 1 to several min depending on rate of inj. Oral: More extended initial half-life. Inhalation: 5 min.
Storage Conditions
 Intravenous: Store at controlled room temperature 20-25°C (68-77°F). Reconstituted solutions: To be used within 24 hr. Parenteral: Store at controlled room temperature 20-25°C (68-77°F). Reconstituted solutions: To be used within 24 hr.
ATC Classification
 C01CA02 - isoprenaline ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of heart failure.
R03AB02 - isoprenaline ; Belongs to the class of adrenergic inhalants, non-selective beta-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
R03CB01 - isoprenaline ; Belongs to the class of adrenergics for systemic use, non-selective beta-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
Storage
 Intravenous: Store at controlled room temperature 20-25°C (68-77°F). Reconstituted solutions: To be used within 24 hr. Parenteral: Store at controlled room temperature 20-25°C (68-77°F). Reconstituted solutions: To be used within 24 hr.
Available As
  • Isoprenaline 2 mg
  • Isoprenaline Sulphate 2 mg
  • Isoprenaline 20 mg
  • Isoprenaline Sulphate 400 mcg

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