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Drug overview for ISOPROTERENOL HCL (isoproterenol hcl):
Generic name: ISOPROTERENOL HCL
Drug class: Beta-Adrenergic Agents
Therapeutic class: Cardiovascular Therapy Agents
Isoproterenol hydrochloride is a synthetic sympathomimetic agent that acts directly on both beta1- and beta2-adrenergic receptors (nonselective beta-agonist).
No enhanced Uses information available for this drug.
Generic name: ISOPROTERENOL HCL
Drug class: Beta-Adrenergic Agents
Therapeutic class: Cardiovascular Therapy Agents
Isoproterenol hydrochloride is a synthetic sympathomimetic agent that acts directly on both beta1- and beta2-adrenergic receptors (nonselective beta-agonist).
No enhanced Uses information available for this drug.
DRUG IMAGES
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The following indications for ISOPROTERENOL HCL (isoproterenol hcl) have been approved by the FDA:
Indications:
Atrioventricular block
Cardiac arrest
Hypovolemic shock
Low cardiac output
Syncope due to heart block
Professional Synonyms:
AV block
Heart arrest
Hypovolemic shock syndrome
Subnormal or depressed cardiac output
Ventricular arrest
Indications:
Atrioventricular block
Cardiac arrest
Hypovolemic shock
Low cardiac output
Syncope due to heart block
Professional Synonyms:
AV block
Heart arrest
Hypovolemic shock syndrome
Subnormal or depressed cardiac output
Ventricular arrest
The following dosing information is available for ISOPROTERENOL HCL (isoproterenol hcl):
Isoproterenol should be initiated at the lowest recommended dose and increased gradually, if necessary, while carefully monitoring the patient.
Isoproterenol hydrochloride usually is administered by direct (''bolus'') IV injection or IV infusion. In extreme emergencies, the drug may be administered by intracardiac injection in adults. In less urgent situations in adults, initial administration by IM or subcutaneous injection is preferred.
For IM, subcutaneous, or intracardiac injection, commercially available isoproterenol hydrochloride injection is administered undiluted. Isoproterenol hydrochloride injection should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. The injection should be discarded if the solution is pinkish or darker than slightly yellow or contains a precipitate.
For IM, subcutaneous, or intracardiac injection, commercially available isoproterenol hydrochloride injection is administered undiluted. Isoproterenol hydrochloride injection should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. The injection should be discarded if the solution is pinkish or darker than slightly yellow or contains a precipitate.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for ISOPROTERENOL HCL (isoproterenol hcl):
There are 1 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Dihydroergotamine/Sympathomimetics SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Concurrent use of dihydroergotamine and sympathomimetics may result in additive or synergistic effect on peripheral blood vessels.(1) CLINICAL EFFECTS: Concurrent use of dihydroergotamine and sympathomimetics may result in increased blood pressure due to peripheral vasoconstriction.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Dihydroergotamine is contraindicated with sympathomimetics because the combination may result in additive or synergistic elevation of blood pressure.(1) DISCUSSION: Significant elevation in blood pressure has been reported in patients treated with dihydroergotamine.(1) Sympathomimetics can be expected to have additional effects on blood pressure. |
DIHYDROERGOTAMINE MESYLATE, MIGRANAL, TRUDHESA |
There are 4 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Ergot Alkaloids/Sympathomimetics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Concurrent use of ergot alkaloids and sympathomimetics may result in additive or synergistic effect on peripheral blood vessels. CLINICAL EFFECTS: Concurrent use of ergot alkaloids and sympathomimetics may result in increased blood pressure due to peripheral vasoconstriction. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: When possible, avoid the concurrent use of ergot alkaloids and sympathomimetics. If concurrent use is warranted, monitor blood pressure and for signs of vasoconstriction. Decreasing the dose of one or both drugs may be necessary. DISCUSSION: There have been reports of severe vasoconstriction resulting in gangrene in patients receiving intravenous ergonovine with dopamine or norepinephrine. |
ERGOLOID MESYLATES, ERGOMAR, ERGOTAMINE TARTRATE, ERGOTAMINE-CAFFEINE, METHYLERGONOVINE MALEATE, METHYSERGIDE MALEATE, MIGERGOT |
| Selected Inhalation Anesthetic Agents/Sympathomimetics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The exact mechanism is unknown. The anesthetics produce conduction changes that increase impulse re-entry into the myocardial tissue.(1) The anesthetics' ability to precipitate arrhythmias is enhanced by elevated arterial blood pressure, tachycardia, hypercapnia, and/or hypoxia, events that stimulate the release of endogenous catecholamines.(1) CLINICAL EFFECTS: Concurrent use of inhalation anesthetic agents and sympathomimetics may result in ventricular arrhythmias or sudden blood pressure and heart rate increase during surgery.(2) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Monitor blood pressure and avoid use of sympathomimetics in patients being treated with anesthetics on the day of surgery.(2) Intravenous use of epinephrine during surgery with halothane and related halogenated general anesthetics should be strongly discouraged. When intravenous epinephrine is necessary, nitrous oxide anesthesia supplemented with ether, muscle relaxants, or opioids should be used instead of halothane.(3,4) Epinephrine may safely be used subcutaneously with the following precautions: the patient is adequately ventilated to prevent hypoxia or respiratory acidosis; the total dose of epinephrine is limited to 100 mcg/10 minute period or 300 mcg/hour in adults, 3.5 mcg/Kg in infants, 2.5 mcg/Kg in children up to two years of age, and 1.45 mcg/Kg in children over two years of age; a minimum effective concentration of anesthetic is maintained; the drugs are not co-administered in patients with hypertension or other cardiovascular disorders; and the cardiac rhythm is continuously monitored during and after injection.(3-10) If arrhythmias occur after the administration of the epinephrine, the drugs of choice are lidocaine or propranolol, depending on the type of arrhythmia.(1) DISCUSSION: Administration of epinephrine during halothane anesthesia may may lead to serious ventricular arrhythmias.(3-6,11-18) This has occurred when epinephrine was administered intravenously,(6) when it was administered with lidocaine as a dental block,(11,14) or when it was administered supraperiosteally.(5) Norepinephrine has been shown to interact with halothane in a manner similar to epinephrine.(1) In two case reports, patients were given terbutaline (0.25 to 0.35 mg) for wheezing following induction of anesthesia with halothane. One patient's heart rate increased from 68 to 100 beats/minute, and the ECG showed premature ventricular contractions and bigeminy, while the other patient developed multiple unifocal premature ventricular contractions and bigeminy. The arrhythmias resolved in both patients following lidocaine administration.(19) Although not documented, isoproterenol causes effects on the heart similar to terbutaline(20) and would probably interact with halothane in a similar manner. Other inhalation anesthetics that increase the incidence of arrhythmias with epinephrine include chloroform,(20) methoxyflurane,(20) and enflurane.(12) A similar interaction may be expected between the other inhalation anesthetics and sympathomimetics. |
DESFLURANE, FORANE, ISOFLURANE, SEVOFLURANE, SUPRANE, TERRELL, ULTANE |
| Selected Direct-Acting Sympathomimetics/Tricyclic Compounds SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Unknown. However, it is speculated that direct-acting sympathomimetic amines have an enhanced effect due to tricyclic blockage of norepinephrine reuptake. CLINICAL EFFECTS: Increased effect of direct acting sympathomimetics. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Consider avoiding the concurrent use of direct-acting sympathomimetics and tricyclic compounds. If concurrent use of direct-acting sympathomimetics and tricyclic compounds is warranted, the initial dose of the sympathomimetic should be lowered and the patient should be monitored for adverse cardiovascular effects. Use of tricyclic compounds and other sympathomimetics should be approached with caution. DISCUSSION: Epinephrine and other direct-acting sympathomimetic amines exert enhanced cardiovascular effects (e.g., arrhythmias, hypertension, and tachycardia) in individuals concurrently receiving or previously treated with tricyclic antidepressants. Other direct and mixed acting sympathomimetic amines have also been reported to interact with tricyclic antidepressants. These include norepinephrine, phenylephrine, dopamine, and methoxamine. Protriptyline, amitriptyline, and desipramine have also been reported to interact with direct-acting sympathomimetics. |
AMITRIPTYLINE HCL, AMOXAPINE, ANAFRANIL, CHLORDIAZEPOXIDE-AMITRIPTYLINE, CLOMIPRAMINE HCL, DESIPRAMINE HCL, DOXEPIN HCL, IMIPRAMINE HCL, IMIPRAMINE PAMOATE, NORPRAMIN, NORTRIPTYLINE HCL, PAMELOR, PERPHENAZINE-AMITRIPTYLINE, PROTRIPTYLINE HCL, SILENOR, TRIMIPRAMINE MALEATE |
| Iobenguane I 123/Agents that Affect Catecholamines SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Many compounds that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells.(1) CLINICAL EFFECTS: Compounds that reduce catecholamine uptake or that deplete catecholamine stores may interfere with imaging completed with iobenguane.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Discuss the use of agents that affect catecholamines. Discontinue drugs that reduce catecholamine uptake or deplete catecholamine stores prior to imaging with iobenguane. Before imaging with iobenguane, discontinue agents that affect catecholamines for at least 5 biological half-lives, as clinically tolerated.(1) DISCUSSION: Many agents may reduce catecholamine uptake or deplete catecholamine stores.(1) Examples include: - CNS stimulants or amphetamines (e.g. cocaine, methylphenidate, dextroamphetamine) - norepinephrine and dopamine reuptake inhibitors (e.g. phentermine) - norepinephrine and serotonin reuptake inhibitors (e.g. tramadol) - monoamine oxidase inhibitors (e.g. phenelzine, linezolid) - central monoamine depleting drugs (e.g. reserpine) - non-select beta adrenergic blocking drugs (e.g. labetalol) - alpha agonists or alpha/beta agonists (e.g. pseudoephedrine, phenylephrine, ephedrine, phenylpropanolamine, naphazoline) - tricyclic antidepressants or norepinephrine reuptake inhibitors (e.g. amitriptyline, bupropion, duloxetine, mirtazapine, venlafaxine) - botanicals that may inhibit reuptake of norepinephrine, serotonin or dopamine (e.g. ephedra, ma huang, St. John's Wort, yohimbine) |
ADREVIEW |
There are 3 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Sympathomimetics (Direct, Mixed-Acting)/Methyldopa SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Unknown. CLINICAL EFFECTS: The pressor response to sympathomimetics may be increased. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Start with low doses of sympathomimetics and monitor blood pressure of patients during concurrent administration of sympathomimetics and methyldopa. DISCUSSION: The pressor response to sympathomimetics has been reported to be increased during methyldopa administration. In addition to increased duration of pressor response, severe hypertension has been reported. |
METHYLDOPA, METHYLDOPA-HYDROCHLOROTHIAZIDE, METHYLDOPATE HCL |
| Entacapone; Opicapone/COMT-Metabolized Agents SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Entacapone and opicapone are selective and reversible inhibitors of catechol-O-methyltransferase (COMT) and drugs that are metabolized by COMT can not be fully metabolized when given with entacapone or opicapone.(1) CLINICAL EFFECTS: COMT-metabolized agents can interact with entacapone or opicapone and may result in an increased heart rates, arrhythmias, or an excessive change in blood pressure.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturers of entacapone and opicapone recommend using caution when administering entacapone or opicapone and a COMT-metabolized agent regardless of the route of administration (including inhalation).(1-3) DISCUSSION: In an interaction study, ventricular tachycardia was observed after epinephrine and entacapone administration.(1) Another study on the effect of entacapone given with isoproterenol and epinephrine concluded that entacapone may potentiate the chronotropic and arrhythmogenic effects of isoproterenol and epinephrine.(4) |
CARBIDOPA-LEVODOPA-ENTACAPONE, ENTACAPONE, ONGENTYS |
| Methacholine/Beta-Agonists; Anticholinergics; Theophylline SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Beta-agonists, anticholinergics, and theophylline may inhibit the action of methacholine on the airway.(1) CLINICAL EFFECTS: The result of the methacholine challenge test may not be accurate.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The following drugs should be held before a methacholine challenge for the the duration indicated:(1) - short-acting beta-agonists: 6 hours - long-acting beta-agonists: 36 hours - short-acting anti-cholinergics: 12 hours - long-acting anti-cholinergics: at least 168 hours (7 days) - oral theophylline: 12-48 hours DISCUSSION: Beta-agonists, anticholinergics, and theophylline may inhibit the action of methacholine on the airway and cause inaccurate test results. |
METHACHOLINE CHLORIDE, PROVOCHOLINE |
The following contraindication information is available for ISOPROTERENOL HCL (isoproterenol hcl):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 4 contraindications.
Absolute contraindication.
| Contraindication List |
|---|
| Angina |
| Digitalis toxicity with AV conduction defects |
| Tachyarrhythmia |
| Tachycardia due to digitalis toxicity |
There are 5 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Acute myocardial infarction |
| Atrioventricular conduction defect |
| Chronic myocardial ischemia |
| Coronary artery disease |
| Hypertension |
There are 2 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Diabetes mellitus |
| Hyperthyroidism |
The following adverse reaction information is available for ISOPROTERENOL HCL (isoproterenol hcl):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 3 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Cardiac arrhythmia Chest pain Paradoxical bronchospasm |
There are 13 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Insomnia Nervousness Xerostomia |
Dizziness Flushing General weakness Headache disorder Hyperhidrosis Hypertension Nausea Tachycardia Tremor Vomiting |
| Rare/Very Rare |
|---|
| None. |
The following precautions are available for ISOPROTERENOL HCL (isoproterenol hcl):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Reproduction studies in rats and rabbits using orally inhaled isoproterenol doses up to 6400 times the usual human dose have not revealed evidence of teratogenic effects. There are no adequate and well-controlled studies using isoproterenol in pregnant women, and the drug should be used during pregnancy only when clearly needed.
Since it is not known whether isoproterenol is distributed into milk, the drug should be used with caution in nursing women.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for ISOPROTERENOL HCL (isoproterenol hcl):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for ISOPROTERENOL HCL (isoproterenol hcl)'s list of indications:
| Atrioventricular block | |
| I44.0 | Atrioventricular block, first degree |
| I44.1 | Atrioventricular block, second degree |
| I44.2 | Atrioventricular block, complete |
| I44.3 | Other and unspecified atrioventricular block |
| I44.30 | Unspecified atrioventricular block |
| I44.39 | Other atrioventricular block |
| Cardiac arrest | |
| I46 | Cardiac arrest |
| I46.2 | Cardiac arrest due to underlying cardiac condition |
| I46.8 | Cardiac arrest due to other underlying condition |
| I46.9 | Cardiac arrest, cause unspecified |
| I97.12 | Postprocedural cardiac arrest |
| I97.120 | Postprocedural cardiac arrest following cardiac surgery |
| I97.121 | Postprocedural cardiac arrest following other surgery |
| I97.71 | Intraoperative cardiac arrest |
| I97.710 | Intraoperative cardiac arrest during cardiac surgery |
| I97.711 | Intraoperative cardiac arrest during other surgery |
| O03.36 | Cardiac arrest following incomplete spontaneous abortion |
| O03.86 | Cardiac arrest following complete or unspecified spontaneous abortion |
| O04.86 | Cardiac arrest following (induced) termination of pregnancy |
| O07.36 | Cardiac arrest following failed attempted termination of pregnancy |
| O08.81 | Cardiac arrest following an ectopic and molar pregnancy |
| O29.11 | Cardiac arrest due to anesthesia during pregnancy |
| O29.111 | Cardiac arrest due to anesthesia during pregnancy, first trimester |
| O29.112 | Cardiac arrest due to anesthesia during pregnancy, second trimester |
| O29.113 | Cardiac arrest due to anesthesia during pregnancy, third trimester |
| O29.119 | Cardiac arrest due to anesthesia during pregnancy, unspecified trimester |
| P29.81 | Cardiac arrest of newborn |
| Hypovolemic shock | |
| R57.1 | Hypovolemic shock |
| Low cardiac output | |
| A48.3 | Toxic shock syndrome |
| I50.21 | Acute systolic (congestive) heart failure |
| I50.23 | Acute on chronic systolic (congestive) heart failure |
| I50.31 | Acute diastolic (congestive) heart failure |
| I50.33 | Acute on chronic diastolic (congestive) heart failure |
| I50.41 | Acute combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.43 | Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure |
| I50.811 | Acute right heart failure |
| I50.813 | Acute on chronic right heart failure |
| O03.31 | Shock following incomplete spontaneous abortion |
| O03.81 | Shock following complete or unspecified spontaneous abortion |
| O04.81 | Shock following (induced) termination of pregnancy |
| O07.31 | Shock following failed attempted termination of pregnancy |
| O08.3 | Shock following ectopic and molar pregnancy |
| O75.1 | Shock during or following labor and delivery |
| R57.0 | Cardiogenic shock |
| T75.01 | Shock due to being struck by lightning |
| T75.01xA | Shock due to being struck by lightning, initial encounter |
| T79.4 | Traumatic shock |
| T79.4xxA | Traumatic shock, initial encounter |
| T81.10 | Postprocedural shock unspecified |
| T81.10xA | Postprocedural shock unspecified, initial encounter |
| T81.11 | Postprocedural cardiogenic shock |
| T81.11xA | Postprocedural cardiogenic shock, initial encounter |
| T81.12 | Postprocedural septic shock |
| T81.12xA | Postprocedural septic shock, initial encounter |
| T81.19 | Other postprocedural shock |
| T81.19xA | Other postprocedural shock, initial encounter |
| T88.2 | Shock due to anesthesia |
| T88.2xxA | Shock due to anesthesia, initial encounter |
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