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Pharmacologic class: Sympathomimetic, adrenergic
Therapeutic class: Inotropic
Pregnancy risk category B
Stimulates beta1-adrenergic receptors of heart, causing a positive inotropic effect that increases myocardial contractility and stroke volume. Also reduces peripheral vascular resistance, decreases ventricular filling pressure, and promotes atrioventricular conduction.
Injection: 12.5 mg/ml in 20-ml vials
Indications and dosages
➣ Short-term treatment of cardiac decompensation caused by depressed contractility (such as during refractory heart failure); adjunct in cardiac surgery
Adults: 2.5 to 10 mcg/kg/minute I.V. as a continuous infusion, adjusted to hemodynamic response
• Elderly patients
• Adjunct in myocardial infarction (MI) and septic shock
• Diagnosis of coronary artery disease (echocardiography stress test, ventriculography, computed tomography)
• Hypersensitivity to drug
• Idiopathic hypertrophic subaortic stenosis
Use cautiously in:
• hypertension, MI, atrial fibrillation, hypovolemia
• pregnant or breastfeeding patients
• As needed, correct hypovolemia before starting therapy by giving volume expanders, as prescribed.
• Use infusion pump or microdrip I.V. infusion set.
• Dilute with dextrose 5% in water or normal saline solution to at least 50 ml of solution. Know that drug is incompatible with alkaline solutions, such as sodium bicarbonate injection.
CV: hypertension, hypotension, tachycardia, premature ventricular contractions, angina, palpitations, nonspecific chest pain, phlebitis
GI: nausea, vomiting
Respiratory: dyspnea, asthma attacks
Skin: extravasation with tissue necrosis
Other: hypersensitivity reactions including anaphylaxis
Drug-drug. Beta-adrenergic blockers: increased alpha-adrenergic effects
Bretylium: potentiation of vasopressor activity
Cyclopropane, halothane: serious arrhythmias
Guanethidine: decreased hypotensive effects
Thyroid hormone: increased cardiovascular effects
Tricyclic antidepressants: potentiation of cardiovascular and vasopressor effects
Drug-herbs. Rue: increased inotropic potential
• Monitor ECG and blood pressure continuously during administration.
• Monitor cardiac output, pulmonary capillary wedge pressure, and central venous pressure.
• Monitor fluid intake and output and watch for signs and symptoms of worsening heart failure.
☞ Assess electrolyte levels. Stay especially alert for hypokalemia.
• Instruct patient to report anginal pain, headache, leg cramps, and shortness of breath.
• Explain need for close observation and monitoring.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.