TAM (Treatments and Medicines) NHS Highland
For use in Critical Care Areas for adults only. Administer via a large peripheral vein or central line (*caution: different strengths*).
MECHANISM OF ACTION:
- Stimulates beta-1 and beta-2 adrenoceptors producing an increase in cardiac output by increasing heart rate and myocardial contractility.
- Half-life = 2.5 to 5 minutes.
USES:
- For bradycardia in patients with adverse signs (systemic hypotension, signs of cerebral hypoperfusion, progressive heart failure, angina, or life-threatening ventricular arrhythmias) and/or risk of asystole which has not responded to atropine, until temporary or permanent pacing can be initiated.
CONTRA-INDICATIONS:
- Recent MI: may increase myocardial oxygen demand.
- Do not give at the same time as adrenaline.
- Ventricular arrhythmias or tachyarrhythmias.
- Heart block due to digoxin toxicity.
- Angina: may exacerbate.
CAUTIONS:
- Phaeochromocytoma.
- Hypotension due to uncorrected hypovolaemia.
- Hyperthyroidism.
PRESENTATION:
- Isoprenaline hydrochloride 1mg in 5mL ampoules.
- Stored in refrigerator.
ADMINISTRATION:
For PERIPHERAL administration (4 micrograms per mL):
- Add 2mg (10mL) to 500mL glucose 5% (withdraw 10mL from bag before adding Isoprenaline) to prepare a 4 microgram per mL solution.
- Glucose 5% is the preferred diluent but sodium chloride 0.9% may be used if there are concerns around hyperglycaemia.
- Administer via a volumetric pump via a large peripheral vein.
For CENTRAL administration (40 micrograms per mL)
- Dilute 2mg (10mL) to 50mL with glucose 5% to prepare a 40 microgram per mL solution.
- Administer via syringe pump.
|
Isoprenaline |
Peripheral Administration |
Central Administration |
|
Prescribe |
2mg in 500mL |
2mg in 50mL |
|
Drug dose to be added |
2mg in 10mL (2 ampoules) |
2mg in 10L (2 ampoules) |
|
Diluent to be added |
490mL glucose 5% (withdraw 10mL from 500mL bag glucose 5% before adding isoprenaline) *Sodium chloride 0.9% may be used if concerns around hyperglycaemia* |
40mL glucose 5% |
|
Final volume |
500mL |
50mL |
|
Final concentration |
4micrograms/mL |
40micrograms/mL |
DOSE AND RATE:
- Usual dose is 1 to 5 micrograms/minute.
- Commence at 1 microgram/minute and titrate upwards at intervals of 2 to 3 minutes until an adequate heart rate is achieved (50 to 60 beats per minute or target set by medical team). Discuss with medical staff before increasing rate further if side-effects such as hypotension or arrhythmias occur.
|
Dose (micrograms/minute) |
Rate (mL/hour) |
Rate (mL/hour) |
|
1 |
15 |
1.5 |
|
2 |
30 |
3.0 |
|
3 |
45 |
4.5 |
|
4 |
60 |
6.0 |
|
5 |
75 |
7.5 |
STABILITY:
- 24 hours.
- Do not allow the syringe or infusion to run out. A syringe or infusion can be made up to a maximum of one hour in advance and labelled clearly with contents and expiry. Refer to local nursing guidelines for switching over infusions or syringes.
EXTRAVASATION:
- The infusion has a low pH and extravasation is likely to cause venous irritation and tissue damage. If given peripherally, use a large vein with monitoring for phlebitis. Resite catheter at first signs of inflammation.
- Please refer to NHS Highland Extravasation Protocol on intranet.
SIDE-EFFECTS:
- Tachycardia and arrhythmias.
- Angina.
MONITORING:
- Continuous ECG and blood pressure monitoring.
- Renal function and urine output/fluid balance.