Note: Patients may exhibit dose-dependent vasodilation due to unopposed beta2-agonism elicited by isoproterenol.
Bradyarrhythmias, AV nodal block: Continuous IV infusion: Usual range: 2 to 10 mcg/minute; titrate to patient response (AHA [Neumar 2010]).
Cardiogenic shock due to bradycardia (off-label use): Continuous IV infusion: 2 to 20 mcg/minute (AHA [van Diepen 2017]).
Provocation during tilt table testing for syncope (off-label use): Continuous IV infusion: Initial: 1 mcg/minute; increase as necessary based on response; maximum dose: 5 mcg/minute (Benditt 1996; Brignole 2004). Note: Timing of initiation and dose adjustment during test may be institution-specific.
Provocation of ventricular arrhythmias in suspected arrhythmogenic right ventricular cardiomyopathy (off-label use): 45 mcg/minute for 3 minutes (regardless of initial heart rate) followed by evaluation for arrhythmia. Note: Perform test after withdrawing beta-blockers, calcium channel blockers, and other antiarrhythmic agents for at least 5 half-lives (Denis 2014).
Torsade de pointes (refractory) (off-label use): Continuous IV infusion: Usual range: 2 to 10 mcg/minute; titrate to patient response (AHA [Neumar 2010]; AHA/ACC/HRS [Al-Khatib 2017]).
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Isoproterenol: Pediatric drug information")
Note: Patients may exhibit dose-dependent vasodilation due to unopposed beta2-agonism elicited by isoproterenol.
Bradycardia, severe; AV nodal block: Limited data available: Infants, Children, and Adolescents: Continuous IV infusion: 0.05 to 0.5 mcg/kg/minute; titrate to effect; doses as high as 2 mcg/kg/minute may be needed in some patients (Park 2014); usual adult range: 2 to 10 mcg/minute (AHA [Neumar 2010])
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection, as hydrochloride:
Isuprel: 0.2 mg/mL (1 mL [DSC], 5 mL [DSC]) [contains disodium edta]
Generic: 0.2 mg/mL (1 mL, 5 mL)
Solution, Injection, as hydrochloride [preservative free]:
Generic: 0.2 mg/mL (1 mL, 5 mL)
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection, as hydrochloride:
Generic: 0.2 mg/mL (1 mL, 5 mL)
IV: IV infusion administration requires the use of an infusion pump.
Parenteral: Administer by continuous IV infusion; requires the use of an infusion pump
IV infusion: 1 mg in 100 mL (10 mcg/mL), 1 mg in 500 mL (2 mcg/mL), or 4 mg in 250 mL (16 mcg/mL) of D5W or NS
IV infusion: 20 mcg/mL
Manufacturer’s labeled indications (see "Note"): Mild or transient episodes of heart block that do not require electric shock or pacemaker therapy; serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation); cardiac arrest until electric shock or pacemaker therapy is available; bronchospasm during anesthesia; adjunct to fluid and electrolyte replacement therapy and other drugs and procedures in the treatment of hypovolemic or septic shock and low cardiac output states (eg, decompensated heart failure, cardiogenic shock)
Note: The use of isoproterenol in advanced cardiac life support (ACLS) has largely been supplanted by the use of other adrenergic agents (eg, epinephrine and dopamine). The use of isoproterenol for bronchospasm during anesthesia and cardiogenic, hypovolemic, or septic shock is no longer recommended. See Off-label Use for more appropriate, yet unlabeled, uses.
Bradycardia (significant hemodynamic compromise); Cardiogenic shock; Provocation during tilt table testing for syncope; Provocation of ventricular arrhythmias in suspected arrhythmogenic right ventricular cardiomyopathy; Short QT-syndrome and ventricular tachycardia/ventricular fibrillation storm; Torsades de pointes
Isuprel may be confused with Disophrol, Isordil
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Cardiovascular: Adams-Stokes syndrome, angina pectoris, flushing, hypertension, hypotension, pallor, palpitations, paradoxical bradycardia (with tilt table testing), tachyarrhythmia, ventricular arrhythmia, ventricular premature contractions
Central nervous system: Dizziness, headache, nervousness, restlessness, seizure (Adams-Stokes)
Dermatologic: Diaphoresis
Endocrine & metabolic: Hypokalemia, increased serum glucose
Gastrointestinal: Nausea, vomiting
Neuromuscular & skeletal: Tremor, weakness
Ophthalmic: Blurred vision
Respiratory: Dyspnea, pulmonary edema
Angina, preexisting ventricular arrhythmias, tachyarrhythmias; cardiac glycoside intoxication
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, coronary artery disease); may increase myocardial oxygen demand resulting in ischemia.
• Diabetes: Use with caution in patients with diabetes mellitus; may transiently increase blood glucose levels.
• Distributive shock: Avoid use in patients with distributive shock; may reduce systemic vascular resistance (SVR) further resulting in hemodynamic compromise.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism; may induce thyroid storm in susceptible individuals.
Special populations:
• Elderly: Use with caution in the elderly.
Dosage form specific issues:
• Sulfites: Contains sulfites; may cause allergic reaction in susceptible individuals.
Other warnings/precautions:
• Appropriate use: Use with extreme caution; not currently a treatment of choice. Excessive or prolonged use may result in decreased effectiveness.
Isoproterenol is not recommended for treatment of bronchospasm. In children with refractory asthma, continuous isoproterenol infusion was associated with myocardial necrosis, congestive heart failure, further clinical deterioration, and death in some cases. The risk of cardiac toxicity was observed to be increased by concomitant corticosteroids or methylxanthines, acidosis, or hypoxemia; monitor patients closely (vital signs, ECG, cardiac enzymes) with therapy.
Substrate of COMT
AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification
COMT Inhibitors: May increase the serum concentration of COMT Substrates. Risk C: Monitor therapy
Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy
Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Inhalational Anesthetics: May enhance the arrhythmogenic effect of Isoproterenol. Risk X: Avoid combination
Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination
Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Risk D: Consider therapy modification
Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy
Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Theophylline Derivatives: Isoproterenol may decrease the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Animal reproduction studies have not been conducted by the manufacturer. Use of isoproterenol may interfere with uterine contractions at term (Mahon 1967).
It is not known if isoproterenol is present in breast milk. The manufacturer recommends that caution be exercised when administering isoproterenol to breastfeeding women.
ECG, heart rate, respiratory rate, arterial blood gas, arterial blood pressure, CVP; serum glucose, serum potassium, serum magnesium
Stimulates beta1- and beta2-receptors resulting in relaxation of bronchial, GI, and uterine smooth muscle, increased heart rate and contractility, vasodilation of peripheral vasculature
Onset of action: IV: Immediate
Duration: IV: 10-15 minutes
Metabolism: Via conjugation in many tissues including hepatic and pulmonary
Half-life elimination: 2.5-5 minutes
Excretion: Urine (primarily as sulfate conjugates)
Solution (Isoproterenol HCl Injection)
0.2 mg/mL (per mL): $40.80 - $264.00
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