II. Indications
- Other inotropic agents (Dobutamine, Amrinone) are preferred over Isoproterenol
- Refractory and hemodynamically significant, Symptomatic Bradycardia (pulse present)
- Specific Uses
- Heart Block
- Bradycardia in denervated transplanted heart
- Unresponsive to other measures
- Atropine
- Epinephrine
- Transcutaneous Pacing or transvenous pacing
- Dopamine
- Specific Uses
III. Contraindications
IV. Precautions
- Decreases Diastolic Blood Pressure
- No alpha adrenergic effect
- Increases Heart Rate (less diastolic filling time)
- May precipitate Myocardial Ischemia
- Increases myocardial oxygen demand
- Decreases coronary perfusion
- Induces Arrhythmias
- Exacerbates tachyarrhythmias due to Digitalis Toxicity
- Precipitates Hypokalemia
V. Dosing: Pediatric Infusion (Same as Epinephrine preparation)
- Preparation
- Draw up "x" mg of Isoproterenol
- Where "x" = 0.6 x Weight in Kilograms
- Add enough D5W or NS for 100 ml total
- At this dilution:
- Infusion rate of 1 ml/h provides 0.1 ug/kg/min
- Start Dose: 10 ml/hour (10 ug/kg/min)
- Titrate to clinical response, adjusting every 5 min
VI. Mechanism
- Synthetic Sympathomimetic amine
- Pure Beta Adrenergic Agonist
- Potent Chronotropic effects (b1)
- Increases Heart Rate (more than Epinephrine)
- Potentiates AV conduction
- Potent Inotropic effects (b1)
- Increases cardiac contractility
- Markedly increases Cardiac Output
- Potent peripheral vasodilatation (b2)
- Decreases Diastolic pressure and mean arterial pressure
- Bronchodilation (b2)
- Endocrine
- Increased Serum Glucose via glycogenolysis and Gluconeogenesis (b2)
- Increased fat breakdown via lipolysis of Triglycerides (b1)
- Other
- Decreased intestinal tone and motility
- Decreases Mast Cell release
- Potent Chronotropic effects (b1)
- Markedly increases myocardial oxygen demand (b1)
- May provoke Myocardial Ischemia
- May decrease coronary perfusion
VII. Pharmacokinetics
- Very short Half-Life (<1.5 minutes)
- As with other Catecholamines, rapid metabolism by COMT (but minimal metabolism by MAO)
VIII. Dosing
- Preparation
- Dissolve 1 mg Isoproterenol in 250 ml D5W (4 mcg/ml, 75 ml/h = 5 mcg/min) OR
- Dissolve 2 mg Isoproterenol in 250 ml D5W (8 mcg/ml, 37.5 ml/h = 5 mcg/min)
- Adult Infusion
- Start Dose: 2 mcg/min IV
- Titrate: 2-10 mcg/min to clinical response
- Target Heart Rate over 60 beats per minute
- Maximum: 20 mcg/min
- Pediatric Infusion
- Start Dose: 0.05 mcg/kg/min IV
- Titrate: Increase by 0.1 mcg/kg/min every 5 to 10 minutes to clinical response
- Target Heart Rate over 60 beats per minute
- Maximum: 2 mcg/kg/min up to 20 mcg/min (or signs of toxicity)
IX. Safety
- Unknown safety in Lactation
- Pregnancy Category C
X. Resources
- Isoproterenol Injection Solution (DailyMed)
- Isoproterenol (Stat Pearls)
XI. References
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- Olson (2020) Clinical Pharmacology, Medmasters, Miami, p. 13-33
- Goldstein (2010) Clin Auton Res 20(6):331-52 +PMID: 20623313 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Definition (NCI) | A synthetic catechol compound and potent beta adrenergic agonist with peripheral vasodilator, bronchodilator, and cardiac stimulating properties. Isoproterenol exerts its effect on the beta-1 adrenergic receptors in the myocardium, thereby increasing heart rate and cardiac output. In addition, isoproterenol acts on beta-2 adrenergic receptors in bronchiolar and vascular smooth muscle, thereby causing smooth muscle relaxation. |
Definition (MSH) | Isopropyl analog of EPINEPHRINE; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. |
Definition (CSP) | synthetic adrenergic agent derived from norepinephrine, having powerful bronchodilator and cardiac stimulant action. |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D007545 |
SnomedCT | 57845006, 372781009 |
English | Isoprenaline, Isopropyl Noradrenaline, Isopropylarterenol, Isopropylnoradrenaline, Isoproterenol, Noradrenaline, Isopropyl, 4-(1-Hydroxy-2-((1-methylethyl)amino)ethyl)-1,2-benzenediol, 1,2-Benzenediol, 4-(1-hydroxy-2-((1-methylethyl)amino)ethyl)-, Isopropylnorepinephrine, isoproterenol preparations (medication), isoproterenol preparations, Isoproterenol [Chemical/Ingredient], isopropylnorepinephrine, isoproteronol, isoprenaline, isoproterenol, ISOPROTERENOL, Isoproteronol, Isoproterenol (product), Isoproterenol (substance) |
Swedish | Isoproterenol |
Czech | isoprenalin, isoproterenol |
Finnish | Isoprenaliini |
French | Isoprotérénol, Isoprénaline |
Russian | DSU, IZADRIN, IZOPROPILARTERENOL, IZUPREL, IZOPRENALIN, DIKHLORIZOPROTERENOL, IZOPROPILNORADRENALIN, IZOPROTERENOL, ДИХЛОРИЗОПРОТЕРЕНОЛ, ДСУ, ИЗАДРИН, ИЗОПРЕНАЛИН, ИЗОПРОПИЛАРТЕРЕНОЛ, ИЗОПРОПИЛНОРАДРЕНАЛИН, ИЗОПРОТЕРЕНОЛ, ИЗУПРЕЛ |
Japanese | ジクロロイソプロテレノール, 硫酸イソプレナリン, イソパール, イソプロテレノール, イソプロピルアルテレノール, イソプロピルノルアドレナリン, イソメニール, スーナー, スーナーL, メジヘラーイソ, イソパールP, 塩酸イソプレナリン, プロタノール, L-イソプレナリン塩酸塩, プロタノールL, メジヘラー・イソ, プロタノールS, L-塩酸イソプレナリン, イソプロピルノルエピネリン, セダンゾール"イソ", アスプール, イソプレナリン |
Spanish | isoprenalina (producto), isoprenalina, isoproterenol, isoproterenol (producto), isoproteronol, isoprenalina (sustancia), isoproterenol (sustancia), Isoprenalina, Isopropilarterenol, Isoproterenol |
Polish | Izoproterenol, Izoprenalina |
German | Isoprenalin, Isopropylarterenol, Isoproterenol |
Italian | Isoproterenolo |
Portuguese | Isoprenalina, Isopropilarterenol, Isoproterenol |