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Isoprenaline Hydrochloride for paediatric complete heart block (1117)

Warning

Objectives

To provide a guideline for the use of Isoprenaline Hydrochloride in paediatric complete heart block.

Scope

This guideline is intended for all healthcare professionals involved in the care of paediatric patients with complete heart block who require treatment with Isoprenaline Hydrochloride.

For neonatal guidance refer to the West of Scotland NEONATAL Parenteral Drug Monographs

Background:

  • Isoprenaline is a non-selective β-adrenoceptor agonist. 
  • At cardiac β1 receptors, Isoprenaline has positive inotropic and chronotropic effects.  This increases cardiac output and heart rate.
  • At β2 receptors, Isoprenaline causes systemic and pulmonary arterial vasodilation.  This leads to a reduction in systemic vascular resistance and bronchodilation.1

Preparations:

Isoprenaline Hydrochloride Injection 1mg/5ml

Dose:

IV Infusion Dose for Complete Heart Block2:

IV Infusion: 0.1-1micrograms/Kg/minute
Infusion rate to be titrated according to clinical response.  Dose may be increased every 2-3 minutes until appropriate response obtained as directed by Consultant Cardiologist.

Route of administration3:

Continuous intravenous infusion, preferably via a central line. 
Isoprenaline has a low PH and may cause venous irritation and tissue damage in cases of extravasation. 
If a central line is not available, administer via a large peripheral vein.

Dilution3:

Diluent : Glucose 5% (preferred) or Nacl 0.9%

Line

Maximum Concentration

PERIPHERAL

20micrograms/ml

CENTRAL

60micrograms/ml


Peripheral line:
Add 1mg (5mls) Isoprenaline hydrochloride to 45mls of diluent to make a final concentration of 1mg/50ml (20micrograms/ml)

If requiring doses greater than 25mls/hour:

Prepare an infusion of 10mg Isoprenaline hydrochloride in 500mls diluent

  • Withdraw 50mls from the 500ml bag of diluent.
  • Add 10mg (50mls) of Isoprenaline hydrochloride to make a final concentration of 10mg/500mls (20micrograms/ml).

Central line: Add 3mg (15ml) Isoprenaline to 35mls of diluent to make a final concentration of 3mg/50ml (60micrograms/ml)

If requiring doses greater than 25mls/hour:

Prepare an infusion of 30mg (150mls) Isoprenaline hydrochloride in 350mls diluent

  • Withdraw 150mls from the 500ml bag of diluent.
  • Add 30mg (150mls) of Isoprenaline hydrochloride to make a final concentration of 30mg/500mls (60micrograms/ml).

To calculate infusion rate:

Infusion rate calculation

Continuous cardiorespiratory monitoring

Including:

  • ECG
  • Blood pressure
  • Oxygen saturations

  • Tachycardia
  • Arrhythmia
  • Palpitations
  • Hypotension
  • Hypertension
  • Tremor
  • Headache
  • Sweating and facial flushing

Editorial Information

Last reviewed: 22/11/2023

Next review date: 30/11/2026

Author(s): Elaine Liston; Donna Nelson.

Version: 1

Approved By: Cardiology Guidelines Group

Document Id: 1117

References

1. SPC Isoprenaline hydrochloride 1 mg/5ml solution for infusion. Tillomed Laboratories Ltd; accessed online 26/09/2023

2. Guys and St Thomas Paediatric Formulary; accessed online 26/09/2023

3. Medusa NHS Injectable Medicines Guide Monograph; Isoprenaline Hydrochloride; accessed online 26/09/2023