📋 Indications & Clinical Dosage
*Inotropic support in infarction, cardiac surgery, cardiomyopathies, septic shock, cardiogenic shock, and during positive end expiratory pressure ventilation:*
BY IV INF: Adult: 2.5-10 mcg/kg/min, adjusted according to response, alternatively0.5-40 mcg/kg/min
Children: Neonate, initially 5 mcg/kg/minute continuous IV INF adjusted according to response to 2-15 mcg/ kg/minute; max. 20 mcg/kg/minute; 1 mth-18 yr, initially 5 mcg/kg/minute adjusted according to response to 2-20 mcg/kg/minute.
*Cardiac stress testing:*
BY IV INF: Adult: Consult product literature.
💊 Mode of Administration
Always administer via infusion device; administer into large vein.Dilute concentrate with at least 50 ml compatible IV soln. A common dilution is 500 mg (40 ml from 250 ml bag) in 210 ml D5W or NS to yield 2000 mcg/ml or dilute 1000 mg (80 ml from 250 ml bag) in 170 ml D5W or NS to yield 4000 mcg/ml. Adjust max conc. according to patients fluid requirements as prescribed. Do not exceed 5000 mcg/ml.
⛔ Contraindications
Pheochromocytoma.
⚠️ Precautions & Warnings
Do not add to alkaline solutions, acute myocardial infarction; correct hypovolaemia, correct atrial fibrillation with rapid ventricular response with digitalis; peripheral vascular resistance may increase if beta-blocker received recently, marked mechanical obstruction. Monitor ECG, blood pressure, pulmonary wedge pressure, cardiac output. Safety in children and pregnancy MI established. Avoid cyclopropane or halogenated hydrocarbon anaesthetics.
🔄 Drug Interactions
General anaesthetics, bretylium, beta-blockers (non-selective ones), guanethidine, MAO inhibitors, methyldopa, reserpine, and tricyclic antidepressants, beta-adrenergic blockers.
⚠️ Adverse Reactions / Side Effects
Nausea; hypotension, hypertension, arrhythmias, palpitations, chest pain; dyspnoea, bronchospasm; headache; fever; increased urinary urgency; eosino-philia; rash, phlebitis; very rarely myocardial infarction, hypokalaemia: coronary artery spasm and thrombocytopenia also reported.
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Caution advised
Lactation / Breastfeeding:
Caution advised
🧪 Compatibility & Storage Stability
Compatibility: Stable in D5LR, D5 'ANS, D5NS, D5W, 010W, LR, VAS, NS, mannitol 20%.
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Stability & Storage: Remix solution every 24 hrs. Store reconstituted solutionin refrigerator for 48 hrs or 6 hrs at room temp. Stability of parenteral admixture at room temp (25C) is 48 hrs; at refrigeration (4C) stability is 7 days.
📚 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.