📋 Indications & Clinical Dosage
*Cardiogenic shock in infarction or cardiac surgery:*
BY IV INF: Adult: Initially 2-5 mcg/kg/min, up to 20 mcg/kg/minute, increased by 1-4 mcg/kg/minute at 10-30 minute interval until desired result, max 50 mcg/kg/minute.
Children 12-18 yrs: Initially 5 mcg/kg/minute adjusted according to response (max 20 mcg/kg/minute).
💊 Mode of Administration
Administer by IV infusion into a large vein using an infusion pump or other infusion control device. Pre-Mixed infusion solutions are suitable for administration without dilution, but the concentrated injection must be diluted for use. The dose of concentrate is added to 250 or 500 ml of compatible solution. Typical dilution is 400 mg in 250 ml to yield 1.6 mg/ml. Do not exceed 3.2 mg/ml.
⛔ Contraindications
Tachyarrhythmia, pheochromocytoma.
⚠️ Precautions & Warnings
Correct hypovolaemia, low dose in shock due to acute myocardial infarction, hyperthyroidism.
🔄 Drug Interactions
MAO inhibitors, alpha- and beta-adrenergic blockers, cocaine, general anaesthesia, methyldopa, phe-nytoin, reserpine, TCAs, guanethidine.
⚠️ Adverse Reactions / Side Effects
Palpitation, Chest pain, dyspnea, headache, hypotension, nausea, vomiting, tachycardia, vasoconstriction. Rare: Bradycardia, gangrene, hypertension, mydriasis. Rare: Fatal ventricular arrhythmias
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Caution advised
Lactation / Breastfeeding:
Caution advised.
🧪 Compatibility & Storage Stability
Compatibility: Stable in D5LR, D5 1/2NS, D5NS, D5W, D1OW, LR, mannitol 20%, NS. Incompatible with sodium bi-carbonate 5 % and alkaline solutions or iron salts. At Y-site administration, incompatible with acyclovir, alteplase, amphdtericin B cholesteryl sulphate complex, cefepime, indomethacin, insulin (regular), thiopental. When admixed, incompatible with acyclovir, alteplase, amphotericin B, ampicillin, metronidazole with sodium bicarbonate, penicillin G potassium.
Stability & Storage: Store vials at controlled room temperature,
15C-30C (59F-86F), and premixed single-use containers at 20C-25C (68F-77F). Brief exposure of premixed single-use containers of up to 40C (104F) does not adversely affect the product. Exposure of pharmaceutical products to heat should be minimized. Avoid excessive heat. Protect from freezing. Avoid contact with alkalies (including sodium bicarbonate), oxidizing agents or iron salts.
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.