Isoproterenol

A to Z Drug Facts

Isoproterenol

	Actions
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(eye-so-pro-TER-uh-nahl)

Isoproterenol Hydrochloride

Isuprel

Injection: (1:5000 solution) 0.2 mg/mL isoproterenol HCl

Isoproterenol Hydrochloride

Injection: (1:5000 solution) 0.2 mg/mL isoproterenol HCl

Injection: (1:50,000) 0.02 mg/mL isoproterenol HCl

Isoproterenol Sulfate

Medihaler-ISO

Aerosol: Delivers 80 mcg isoproternol sulfate/actuation

Class: Bronchodilator, Sympathomimetic

Actions Produces bronchodilation by relaxing bronchial smooth muscle through beta-2 receptor stimulation; increases heart rate and myocardial contractility by stimulating cardiac beta-1 receptors, which increases cardiac output.

Indications Management of bronchospasm during anesthesia; adjunctive treatment for shock.

Contraindications Cardiac arrhythmias associated with tachycardia; tachycardia or heart block caused by digitalis intoxication; angina; ventricular arrhythmias requiring inotropic therapy.

Route/Dosage

Bronchospasm

ADULTS: IV 0.01 to 0.02 mg. Repeat as necessary. Isoproterenol for shock is generally given IV (1:5000), starting at a low dose and adjusting individually.

Interactions

Cardiac Glycosides: Arrhythmias may result with coadministration. General Anesthetics (eg, Halothane, Cyclopropane): Arrhythmias may result with coadministration. Ergot Alkaloids: Coadministration may result in additive peripheral vasoconstriction.

Lab Test Interferences

Bilirubin may be falsely elevated if measured by sequential multiple analyzer. Urinary epinephrine values may be elevated.

Adverse Reactions

CARDIOVASCULAR: Palpitations; tachycardia; blood pressure changes; arrhythmias; Adams-Stokes attacks; cardiac arrest. CNS: Tremor; dizziness; nervousness; drowsiness; headache; insomnia. GI: Nausea; GI distress. RESPIRATORY: Cough; throat irritation; bronchitis; sputum increase; pulmonary edema. OTHER: Parotid gland swelling with prolonged use; saliva discoloration; sweating; skin flushing.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Labor and Delivery: May inhibit uterine contractions and delay preterm labor. CHILDREN: Safety and efficacy of inhalation products in children £ 12 yr not established. Elderly: Lower doses may be required. Cardiovascular Effects: Toxic symptoms in patients with cardiovascular disorders may occur. Doses sufficient to increase the heart rate > 130 bpm may induce ventricular arrhythmias. CNS Effects: Use cautiously in patients with history of seizures or hyperthyroidism. Diabetes: Dosage adjustment of insulin or oral hypoglycemic agent may be required. Usual Dose Response: Closely supervise patients requiring > 3 aerosolized treatments. Further therapy is inadvisable when 3 to 5 treatments within 6 to 12 hr produce minimal or no relief. Excessive Use: Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Combined Therapy: Do not use ³ 2 beta-adrenergic aerosol bronchodilators simultaneously because of potential for additive effects. Do not use as a substitute for oral or inhaled corticosteroids. Saliva Discoloration: Isoproterenol may cause saliva to turn pinkish-red.

PATIENT CARE CONSIDERATIONS

Administration/Storage

IV Injection

Dilute 1 mL of 1:5000 solution to 10 mL with 5% Sodium Chloride or Dextrose Injection to achieve 1:50,000 solution.

IV Infusion

Dilute 10 mL 1:5000 solution in 500 mL 5% Dextrose to produce 1:250,000 solution. Use microdrip or continuous infusion pump to prevent sudden influx of large amount of drug.

Metered Dose Inhaler

Shake container thoroughly to activate medication. Instruct patient in proper technique for use.

IPPB

Position patient properly for treatment, either sitting or in semi-Fowler position. Have patient rinse mouth after each session.

Nebulizer

Find location where patient can sit comfortably for 10 to 15 min. Do not mix different types of medication without consulting the package insert. Instruct patients to take slow, deep breaths and, if possible, hold breath for 10 sec before slowly exhaling. Continue until medication chamber is empty.
Discard solution if precipitate or discoloration are present.
Store in tight, light-resistant container at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Monitor heart rate, respirations, BP, and urine output. Carefully monitor heart rate and rhythm and ECG pattern when used as treatment for shock.

OVERDOSAGE: SIGNS & SYMPTOMS
	Tremor, palpitations, angina, arrhythmias, tachycardia, elevated or decreased blood pressure, seizures, nervousness, headache, dry mouth, nausea, dizziness, fatigue, malaise, insomnia

Patient/Family Education

Use verbal instructions and demonstrations to teach technique for inhalation therapy and explain that if > 1 inhalation is necessary, patient should wait 3 to 5 min between doses.
Tell patient to notify health care provider if no response to usual dose.

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