fenoldopam mesylate

fenoldopam mesylate

Corlopam

Pharmacologic class: Dopamine receptor agonist (vasodilator)

Therapeutic class: Emergency antihypertensive

Pregnancy risk category B

Action

Stimulates dopamine₁ postsynaptic receptors, causing vasodilation, decreasing blood pressure and total peripheral resistance, and increasing renal blood flow

Availability

Ampules: 10 mg/ml in single-dose, 5-ml ampules

⊘Indications and dosages

➣ Short-term (up to 48 hours) hospital management of severe hypertension when rapid blood pressure reduction is indicated

Hospitalized adults: Dosages highly individualized based on rate and magnitude of desired blood pressure decrease. Dosages of 0.01 to 1.6 mcg/kg/minute I.V. infusion have been studied in clinical trials. Titrate upward or downward no more often than q 15 minutes to achieve desired blood pressure, at recommended increments of 0.05 to 0.1 mcg/kg/minute.

➣ Short-term (up to 4 hours) blood pressure reduction in hospitalized children

Hospitalized children: Dosages highly individualized based on rate and magnitude of desired blood pressure decrease. Dosages of 0.2 mcg/kg/minute I.V. were used initially in clinical trials; dosage increases up to 0.3 to 0.5 mcg/kg/minute q 20 to 30 minutes for up to 4 hours were well tolerated; dosages above 0.8 mcg/kg/minute have produced tachycardia with no additional benefit.

Contraindications

• Hypersensitivity to drug or sulfites

Precautions

Use cautiously in:
• glaucoma, increased intraocular pressure (IOP), tachycardia, hypotension, hypokalemia, hepatic disease
• patients receiving concurrent beta-adrenergic blockers.

Administration

☞ Don't give as I.V. bolus. Give only by slow, continuous I.V. infusion using infusion pump, at a concentration of 40 mcg/ml or less (60 mcg/ml or less for children).
• Be aware that compatible solutions are 0.9% sodium chloride injection and 5% dextrose injection.

Route	Onset	Peak	Duration
I.V.	15 min	20 min	Unknown

Adverse reactions

CNS: anxiety, dizziness, headache, light-headedness, insomnia, nervousness

CV: angina pectoris, nonspecific chest pain, hypotension, palpitations, ST-segment and T-wave changes, tachycardia, bradycardia, heart failure, ischemic heart disease, myocardial infarction

EENT: increased IOP, nasal congestion

GI: nausea, vomiting, diarrhea, constipation, abdominal pain and fullness

GU: urinary tract infection, oliguria

Hematologic: leukocytosis, bleeding tendency

Metabolic: hypokalemia

Musculoskeletal: leg cramps, back pain

Respiratory: dyspnea, upper respiratory tract infection

Skin: diaphoresis, flushing

Other: injection site pain, fever, hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug. Beta-adrenergic blockers: increased hypotension

Dopamine antagonists, metoclopramide: decreased fenoldopam effects

Drug-diagnostic tests. Aminotransferase, blood urea nitrogen, creatinine, glucose, lactate dehydrogenase, potassium: decreased levels

Patient monitoring

• Watch closely for signs and symptoms of anaphylaxis or severe asthma.
☞ Check blood pressure carefully at least every 15 minutes to detect hypotension, especially in patient with acute cerebral infarction or hemorrhage.
• When desired blood pressure decrease occurs, discontinue therapy or taper dosage as ordered.
• Know that patients with asthma are at higher risk for sulfite sensitivity.
• Assess respiratory and cardiac status regularly.
• Monitor potassium level closely.
• Evaluate fluid intake and urinary output.

Patient teaching

☞ Tell patient to immediately report signs or symptoms of anaphylaxis or breathing problems.
• Tell patient that drug may cause rapid heart rate and excessively lower blood pressure, possibly resulting in dizziness.