Isoproterenol

ISUPREL

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Isoproterenol ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Isoproterenol ballicule

What it isNon-selective beta agonist; bradyarrhythmia, heart block and torsades.

Why this onePure beta agonism raises rate and contractility without alpha vasoconstriction, so it is used as a chemical pacemaker.

What limits itTachyarrhythmia and myocardial ischemia from raised oxygen demand. Hypotension from beta-2 vasodilation.

Isoproterenol molecular structure (skeletal formula) — Molecular structure: Isoproterenol

FDA-approved for

bradyarrhythmias / heart block (1956)

FDA label

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FDA dosing	Population	Start	Target	Max
Shock and hypoperfusion states	Adult	0.5 mcg/min IV infusion	0.5-5 mcg/min IV infusion (titrate)	>30 mcg/min used in advanced shock
Bronchospasm during anesthesia	Adult	10-20 mcg IV bolus	10-20 mcg IV bolus PRN
Infusion (AHA, safety not established)	Pediatric	0.1 mcg/kg/min	0.1-1 mcg/kg/min IV infusion

Renal Undefined

Hepatic Undefined

Bronchospasm bolus (10-20 mcg) may be repeated when necessary.

Instructions

IV use; start at the lowest dose and titrate to response
Adjust infusion by heart rate, CVP, blood pressure and urine flow; reduce or briefly stop if HR >110 bpm
Inspect for particulate matter/discoloration; do not use if pinkish, darker than slightly yellow, or containing precipitate

Available strengths

inj 0.2 mg/mL

Contraindications

Tachycardia
Ventricular arrhythmias
Angina pectoris

Cautions

May induce cardiac arrhythmias and myocardial ischemia, esp. with coronary artery disease or cardiomyopathy

Adverse reactions

Tachycardia, palpitations, tachyarrhythmias, angina
Nervousness, headache, dizziness
Flushing, sweating, tremor, nausea
Dyspnea; pulmonary edema (rare)

Pregnancy Decades of use show no drug-associated birth-defect risk; avoid during 2nd stage of labor and when maternal BP >130/80.

Lactation No data; low infant exposure expected given short half-life.

Cost

Isoproterenol (ISUPREL)

Strength		#/mo	generic $/unit	CostPlus
0.2 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Isoproterenol is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

NO BOXED WARNINGS

Principal riskTachyarrhythmia and myocardial ischemia

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Defining liabilityTachyarrhythmia and myocardial ischemia

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