Protocol for the Iv Administration of Isoprenaline

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PROTOCOL FOR THE IV ADMINISTRATION OF ISOPRENALINE INFORMATION/INDICATIONS Isoprenaline stimulates both β1 and β2 adrenoceptors producing an increase in cardiac output by increasing both myocardial contractility and heart rate. In patients with systemic hypotension, signs of cerebral hypoperfusion, progressive heart failure, angina, or life-threatening ventricular arrhythmia, medical therapy should be started immediately until temporary pacing is initiated. External pacing does not provide reliable ventricular stimulation and should only be considered when administration of a chronotropic drug, temporary or permanent pacing is not available. Currently we are only able to obtain isoprenaline sulfate 5mg/5ml. Isoprenaline sulfate 2.25mg = Isoprenaline hydrochloride 2mg All prescriptions should be prescribed in terms of isoprenaline hydrochloride. There are various strengths and salts of isoprenaline. ADMINISTRATION Preferably administered via a central venous access to avoid potential venous irritation as the preparation has a low pH. IV infusion via peripheral administration (in emergencies): Please ensure that you double check the strength and salt form of preparation being administered and volume to be added to infusion bag. The dose used for severe bradycardia is 1 – 4micrograms/min given by intravenous infusion. Isoprenaline sulfate 5mg/5ml injection (unlicensed) Remove 2.25ml from a 500ml bag of 5% Glucose Add 2.25mls (2.25mg) of isoprenaline to a 500ml bag of 5% Glucose Agitate to mix Do NOT use Sodium Chloride 0.9% This provides a final concentration of 2mg in 500mls (isoprenaline hydrochloride), which is equivalent to 4micrograms/ml. Commence infusion at a rate of 1micrograms/min (15mls/hr). Dose in microgram/min 1 2 3 4 5 6 7 8 9 10 Infusion rate (ml/hr) 15 30 45 60 75 90 105 120 135 150 Consider titrating up in steps of 1micrograms/min at intervals of 2-3 minutes, until a satisfactory heart rate is achieved or adverse effects such as hypotension or ventricular arrhythmias occur. (Usual max: 10micrograms/min) IV infusion in fluid restriction (central line only): Isoprenaline sulfate 5mg/5ml injection (unlicensed) Remove 2.25ml from a 50ml bag of 5% Glucose Add 2.25mls of isoprenaline (2.25mg) to a 50ml bag of 5% Glucose Agitate to mix Do NOT use Sodium Chloride 0.9% This provides a final concentration of 2mg in 50mls (isoprenaline hydrochloride), which is equivalent to 40micrograms/ml. Commence infusion at a rate of 1micrograms/min (1.5mls/hr) Dose in microgram/min 1 2 3 4 5 6 7 8 9 10 Infusion rate (ml/hr) 1.5 3 4.5 6 7.5 9 10.5 12 13.5 15 CAUTIONS Isoprenaline should be used with caution in patients with ischaemic heart disease, diabetes, hypertension and hyperthyroidism. SIDE EFFECTS Arrhythmias, sweating, tremor, headache and flushing. DATE PREPARED REVIEW DATE PREPARED BY CHECKED BY Ceri Jones Sian-Tsung Tan January 2017 January 2020 Critical Care Pharmacist Cardiology SpR December 2018 UPDATED: Sukhpreet Sahota Rotational Medicines specialist Pharmacist January 2021 UPDATED: Reena Pankhania Julie Phillips Rotational Medicines Information MI/Formulary Pharmacist Pharmacist Approved by the Drugs & Therapeutics Committee. Questions to [email protected] ext 7114. .

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Genl:VE 1970 © World Health Organization 1970
Nathan B. Eddy, Hans Friebel, Klaus-Jiirgen Hahn & Hans Halbach WORLD HEALTH ORGANIZATION ORGANISATION .MONDIALE DE LA SANT~ GENl:VE 1970 © World Health Organization 1970 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. Nevertheless governmental agencies or learned and professional societies may reproduce data or excerpts or illustrations from them without requesting an authorization from the World Health Organization. For rights of reproduction or translation of WHO publications in toto, application should be made to the Division of Editorial and Reference Services, World Health Organization, Geneva, Switzerland. The World Health Organization welcomes such applications. Authors alone are responsible for views expressed in signed articles. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Director-General of the World Health Organization concerning the legal status of any country or territory or of its authorities, or concerning the delimitation of its frontiers. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. © Organisation mondiale de la Sante 1970 Les publications de l'Organisation mondiale de la Sante beneficient de la protection prevue par les dispositions du Protocole n° 2 de la Convention universelle pour la Protection du Droit d'Auteur. Les institutions gouvernementales et les societes savantes ou professionnelles peuvent, toutefois, reproduire des donnees, des extraits ou des illustrations provenant de ces publications, sans en demander l'autorisation a l'Organisation mondiale de la Sante. Pour toute reproduction ou traduction integrate, une autorisation doit etre demandee a la Division des Services d'Edition et de Documentation, Organisation mondiale de la Sante, Geneve, Suisse.
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