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a vasodilator used for short-term, inpatient management of severe hypertension, administered intravenously as the mesylate salt.
Pregnancy Category: B
Short-term (<48 hr), in-hospital management of hypertensive emergencies, including malignant hypertension with end-organ deterioration.
Acts as an agonist at dopamine d1-like receptors.
Also binds to alpha-adrenergic receptors.
Acts as a vasodilator.
Rapid lowering of BP.
Absorption: IV administration results in complete bioavailability.
Metabolism and Excretion: Mostly metabolized by the liver; 90% of metabolites are excreted in urine, 10% in feces.
Half-life: 5–10 min.
Time/action profile (effect on BP)
|IV||rapid||15 min||1–4 hr|
Contraindicated in: Hypersensitivity to fenoldopam or sulfites; Concurrent beta blocker therapy (will prevent reflex tachycardia).
Use Cautiously in: Glaucoma or intraocular hypertension; Obstetric / Pediatric / Lactation: Safety not established.
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
- hypotension (most frequent)
- tachycardia (most frequent)
- ECG changes
- peripheral edema
- nausea (most frequent)
- abdominal pain
- flushing (most frequent)
Fluid and Electrolyte
- injection site reactions
- back pain
Drug-Drug interactionConcurrent use with beta blockers may result in excessive hypotension (concurrent use should be avoided).
Intravenous (Adults) 0.01–1.6 mcg/kg/min.
Concentrate for injection: 10 mg/mL in 1– and 2-mL single-use ampules (with sodium meta-bisulfite)
- Monitor BP, heart rate, and ECG frequently throughout therapy; continuous monitoring is preferred. Consult physician for parameters.
- Lab Test Considerations: Monitor serum potassium concentrations every 6 hr during therapy. May cause hypokalemia. Treat with oral or IV potassium supplementation.
Potential Nursing DiagnosesIneffective tissue perfusion (Indications)
- pH: 2.8–3.8.
- Administer via continuous infusion; do not use bolus doses. Avoid hypotension and rapid decreases in BP. Initial dose titration should occur no more frequently than every 15 min and less frequently as desired BP is reached. Increments of 0.05 to 0.1 mcg/kg/min are recommended for titration. Lower initial doses (0.03 to 0.1 mcg/kg/min) titrated slowly have been associated with less reflex tachycardia than higher initial doses.
- Infusion can be abruptly discontinued or gradually tapered before discontinuation. Oral therapy with other antihypertensives can begin anytime after the BP is stable. Do not administer beta blockers concurrently with fenoldopam.
- Continuous Infusion: Diluent: Dilute 4 mL (40 mg of drug) with 1000 mL, 2 mL (20 mg of drug) with 500 mL, or 1 mL (10 mg of drug) with 250 mL of 0.9% NaCl or D5W. Infusion is stable for 24 hr at room temperature. Concentration: 40 mcg/mL.
- Rate: Based on patient's weight (see Route/Dosage section). Titrate to desired effect. Administer via infusion pump to ensure accurate dosage rate.
- Y-Site Compatibility: alfentanil, amikacin, aminocaproic acid, amiodarone, ampicillin/sulbactam, argatroban, atracurium, atropine, azithromycin, aztreonam, butorphanol, calcium chloride, calcium gluconate, caspofungin, cefazolin, cefepime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, cimetidine, ciprofloxacin, cisatracurium, clindamycin, cyclosporine, daptomycin, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, dolasetron, dopamine, doxycycline, droperidol, enalaprilat, epinephrine, ertapenem, erythromycin, esmolol, famotidine, fentanyl, fluconazole, gentamicin, granisetron, haloperidol, heparin, hydralazine, hydrocortisone sodium succinate, hydromorphone, imipenem/cilastatin, insulin, isoproterenol, labetalol, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, meperidine, metoclopramide, metoprolol, metronidazole, micafungin, midazolam, milrinone, morphine, nafcillin, nalbuphine, naloxone, nicardipine, nitroglycerin, nitroprusside, norepinephrine, ondansetron, palonosetron, pancuronium, phenylephrine, piperacillin/tazobactam, potassium chloride, potassium phosphate, procainamide, promethazine, propofol, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sufentanil, tacrolimus, theophylline, ticarcillin/clavulanate, tirofiban, tobramycin, trimethoprim/sulfamethoxazole, vancomycin, vasopressin, vecuronium, verapamil, voriconazole
- Y-Site Incompatibility: acyclovir, aminophylline, amphotericin B, ampicillin, bumetanide, cefoxitin, dexamethasone sodium phosphate, diazepam, fosphenytoin, furosemide, ganciclovir, ketorolac, meropenem, methohexital, methylprednisolone sodium succinate, pantoprazole, pentobarbital, phenytoin, prochlorperazine, sodium bicarbonate, thiopental
- Explain purpose of medication to patient.
- Advise patient to report headache or pain at the injection site.
- Decrease in BP without the appearance of side effects.
fenoldopam/fe·nol·do·pam/ (fe-nol´do-pam) a vasodilator used for short-term, inpatient management of severe hypertension; used as the mesylate salt.
indications It is used to treat hypertensive crisis when an urgent decrease of pressure is required, including malignant hypertension.
contraindications Known hypersensitivity to this drug and sulfite sensitivity prohibit its use.
adverse effects Life-threatening effects are hypotension, myocardial infarction, ischemic heart disease, and leukocytosis. Other adverse effects include anxiety, dizziness, ST-T wave changes, angina pectoris, palpitations, nausea, vomiting, constipation, diarrhea, bleeding, and increased levels of blood urea nitrogen, glucose, lactic dehydrogenase, creatinine, and hypokalemia. Headache is a common side effect.