Fenoldopam Uses, Dosage, Side Effects & Price | DrugsAtlas
Authoritative Clinical Reference
DRUG NAME: Fenoldopam
Therapeutic Class: Antihypertensive
Subclass: Peripheral dopamine-1 (DA1) receptor agonist
Speciality: Critical Care Medicine
Schedule (India): Schedule H
Route(s): Intravenous (IV)
Formulations Available in India:
• Fenoldopam injection: 10 mg/mL in 1 mL ampoule (concentrate for dilution)
• Fenoldopam injection: 10 mg/mL in 2 mL ampoule
• Fenoldopam injection: 10 mg/mL in 2 mL ampoule
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
1. Hypertensive Emergency (including patients with renal impairment or perioperative hypertension)
| Parameter | Recommendation |
| Starting dose | 0.1 mcg/kg/min IV continuous infusion |
| Titration | Increase by 0.05–0.1 mcg/kg/min every 15–20 minutes based on BP response |
| Usual maintenance dose | 0.1–0.3 mcg/kg/min |
| Maximum dose | 1.6 mcg/kg/min |
Clinical Notes:
→ Onset of action: within 5 minutes; duration of effect: 30–60 minutes after discontinuation
→ Requires continuous invasive or non-invasive arterial BP monitoring
→ Preserves or enhances renal blood flow — preferred agent in patients with acute kidney injury or renal compromise
→ Must be diluted before infusion; do not administer as bolus
→ Prepare infusion fresh; stable for 24 hours at room temperature once diluted
→ Onset of action: within 5 minutes; duration of effect: 30–60 minutes after discontinuation
→ Requires continuous invasive or non-invasive arterial BP monitoring
→ Preserves or enhances renal blood flow — preferred agent in patients with acute kidney injury or renal compromise
→ Must be diluted before infusion; do not administer as bolus
→ Prepare infusion fresh; stable for 24 hours at room temperature once diluted
Secondary Indications – Adults (Off-label, if any)
1. Controlled Hypotension During Surgery (OFF-LABEL)
• Dose: 0.05–0.5 mcg/kg/min IV infusion
• Duration: Intraoperative period only; discontinue at end of surgery
• Specialist only: Anaesthesiologist supervision required
• Evidence basis: Institutional protocols in neurosurgery and major vascular procedures
• Dose: 0.05–0.5 mcg/kg/min IV infusion
• Duration: Intraoperative period only; discontinue at end of surgery
• Specialist only: Anaesthesiologist supervision required
• Evidence basis: Institutional protocols in neurosurgery and major vascular procedures
2. Renal Protection in High-Risk Cardiac Surgery (OFF-LABEL)
• Dose: 0.03–0.1 mcg/kg/min IV infusion
• Duration: Initiated perioperatively; continued for up to 24 hours postoperatively
• Specialist only: Cardiac anaesthesia/ICU settings
• Evidence basis: Mixed results in RCTs; some centres use as part of renal protection protocols
• Dose: 0.03–0.1 mcg/kg/min IV infusion
• Duration: Initiated perioperatively; continued for up to 24 hours postoperatively
• Specialist only: Cardiac anaesthesia/ICU settings
• Evidence basis: Mixed results in RCTs; some centres use as part of renal protection protocols
PAEDIATRIC DOSING (Specialist Only)
Primary Indications (Approved / Standard in India)
Hypertensive Crisis (Age >1 month) — ICU/Specialist Setting Only
| Parameter | Recommendation |
| Starting dose | 0.2 mcg/kg/min IV continuous infusion |
| Titration | Increase by 0.05–0.1 mcg/kg/min every 15–30 minutes |
| Usual maintenance dose | 0.2–0.5 mcg/kg/min |
| Maximum dose | 0.8 mcg/kg/min |
Clinical Notes:
→ Continuous arterial BP monitoring mandatory
→ Monitor urine output hourly
→ Minimum age: >1 month (safety in neonates not established)
→ Use only in paediatric ICU with specialist supervision
→ Monitor for hypotension and reflex tachycardia
→ Continuous arterial BP monitoring mandatory
→ Monitor urine output hourly
→ Minimum age: >1 month (safety in neonates not established)
→ Use only in paediatric ICU with specialist supervision
→ Monitor for hypotension and reflex tachycardia
Secondary Indications – Paediatric doses (Off-label, if any)
• Not routinely established in paediatric practice
• Any off-label use requires paediatric critical care or cardiology specialist input
• NOT RECOMMENDED in neonates (<1 month) except under specialist supervision in tertiary centres
• Any off-label use requires paediatric critical care or cardiology specialist input
• NOT RECOMMENDED in neonates (<1 month) except under specialist supervision in tertiary centres
RENAL ADJUSTMENT
• No dose adjustment required in renal impairment
• Drug possesses renal vasodilatory properties via DA1 receptor activation — increases renal blood flow
• Often preferred over other IV antihypertensives in patients with elevated creatinine or oliguria
• Safe to use in patients on haemodialysis
• Drug possesses renal vasodilatory properties via DA1 receptor activation — increases renal blood flow
• Often preferred over other IV antihypertensives in patients with elevated creatinine or oliguria
• Safe to use in patients on haemodialysis
HEPATIC ADJUSTMENT
| Severity (Child-Pugh) | Recommendation |
| Class A (Mild) | No dose adjustment required |
| Class B (Moderate) | Use with caution; initiate at lower end of dosing range; slower titration |
| Class C (Severe) | Use only in ICU setting with close haemodynamic monitoring |
CONTRAINDICATIONS
• Known hypersensitivity to fenoldopam or any excipient
• Acute angle-closure glaucoma or conditions predisposing to elevated intraocular pressure
• Sulphite allergy (some formulations contain sodium metabisulphite)
• Severe uncorrected hypovolaemia or shock states
• Acute angle-closure glaucoma or conditions predisposing to elevated intraocular pressure
• Sulphite allergy (some formulations contain sodium metabisulphite)
• Severe uncorrected hypovolaemia or shock states
CAUTIONS
• Volume depletion — correct hypovolaemia before initiating therapy to prevent profound hypotension
• Coronary artery disease — reflex tachycardia may precipitate myocardial ischaemia
• Elevated intraocular pressure — may exacerbate glaucoma
• Concurrent use of potassium-depleting agents — risk of hypokalaemia
• Tachyarrhythmias — may worsen with reflex sympathetic activation
• Aortic stenosis or hypertrophic cardiomyopathy — hypotension may be poorly tolerated
• Coronary artery disease — reflex tachycardia may precipitate myocardial ischaemia
• Elevated intraocular pressure — may exacerbate glaucoma
• Concurrent use of potassium-depleting agents — risk of hypokalaemia
• Tachyarrhythmias — may worsen with reflex sympathetic activation
• Aortic stenosis or hypertrophic cardiomyopathy — hypotension may be poorly tolerated
PREGNANCY
| Parameter | Guidance |
| Overall safety | Limited human data; animal studies inconclusive |
| When permissible | Only in severe refractory hypertensive emergency when standard agents inadequate; ICU/specialist setting |
| Preferred alternatives | Labetalol IV, hydralazine IV, nifedipine oral (per Indian obstetric guidelines) |
| Monitoring | Continuous maternal BP; fetal heart rate monitoring; assess uteroplacental perfusion |
LACTATION
| Parameter | Guidance |
| Breastfeeding compatibility | Unknown; use not routinely recommended during active breastfeeding |
| Milk levels | Not established; expected low due to short half-life |
| Preferred alternatives | Labetalol IV or hydralazine IV |
| Infant monitoring | If used, observe for hypotension, poor feeding, lethargy |
ELDERLY
• Starting dose: 0.05–0.1 mcg/kg/min (use lower end of range)
• Titration: Slower increments (0.05 mcg/kg/min every 20–30 minutes)
• Increased risk of:
• Titration: Slower increments (0.05 mcg/kg/min every 20–30 minutes)
• Increased risk of:
- Excessive hypotension
- Reflex tachycardia precipitating ischaemia
- Falls upon mobilisation post-infusion
• ECG monitoring recommended in patients with known cardiovascular disease
• Ensure adequate volume status before initiation
MAJOR DRUG INTERACTIONS
| Interacting Drug | Effect | Management |
| Non-selective beta-blockers (propranolol) | May unmask alpha-mediated vasoconstriction; paradoxical hypertension possible in some cases; also blunts compensatory tachycardia | Avoid concurrent use or use cardioselective beta-blocker with caution |
| MAO inhibitors | Potentiation of hypotensive effect; unpredictable response | AVOID — discontinue MAOIs at least 14 days before |
| IV nitroglycerin/nitroprusside | Additive profound hypotension | Avoid concurrent use; if essential, reduce doses of both agents |
MODERATE DRUG INTERACTIONS
| Interacting Drug | Effect | Management |
| Loop diuretics (furosemide) | Additive hypotension; additive hypokalaemia | Monitor BP closely; check serum potassium every 6–12 hours |
| Thiazide diuretics | Potentiates hypokalaemia | Monitor electrolytes |
| ACE inhibitors/ARBs | Additive hypotension, especially in volume-depleted patients | Monitor BP; ensure euvolaemia |
| Alpha-blockers (prazosin, tamsulosin) | Additive antihypertensive effect | Monitor for symptomatic hypotension |
| Inhalational anaesthetics (sevoflurane, isoflurane) | Enhanced hypotensive response | Dose adjustment during anaesthesia; anaesthetist coordination |
| NSAIDs | May attenuate renal vasodilatory benefit | Avoid in patients where renal protection is a treatment goal |
COMMON ADVERSE EFFECTS
• Headache
• Flushing
• Nausea
• Dizziness
• Reflex tachycardia
• Injection site reactions
• Hypokalaemia (with prolonged infusion)
• Flushing
• Nausea
• Dizziness
• Reflex tachycardia
• Injection site reactions
• Hypokalaemia (with prolonged infusion)
SERIOUS ADVERSE EFFECTS
• Severe symptomatic hypotension — may require fluid resuscitation and dose reduction
• Myocardial ischaemia or angina — secondary to reflex tachycardia; may require discontinuation
• Acute angle-closure glaucoma — discontinue immediately; ophthalmology referral
• Significant hypokalaemia — can precipitate arrhythmias; requires IV potassium supplementation
• Anaphylaxis or severe hypersensitivity (rare; associated with sulphite content) — discontinue; supportive care
• Myocardial ischaemia or angina — secondary to reflex tachycardia; may require discontinuation
• Acute angle-closure glaucoma — discontinue immediately; ophthalmology referral
• Significant hypokalaemia — can precipitate arrhythmias; requires IV potassium supplementation
• Anaphylaxis or severe hypersensitivity (rare; associated with sulphite content) — discontinue; supportive care
MONITORING REQUIREMENTS
Baseline:
• Blood pressure (arterial line preferred in ICU)
• Heart rate and ECG (especially if cardiac disease)
• Serum electrolytes including potassium
• Renal function (serum creatinine, urine output)
• Assess volume status
• Blood pressure (arterial line preferred in ICU)
• Heart rate and ECG (especially if cardiac disease)
• Serum electrolytes including potassium
• Renal function (serum creatinine, urine output)
• Assess volume status
During Infusion:
• Continuous BP monitoring (arterial line or every 5 minutes non-invasively during titration)
• Heart rate every 15–30 minutes
• Hourly urine output
• Serum potassium every 6–12 hours for prolonged infusions (>24 hours)
• Continuous BP monitoring (arterial line or every 5 minutes non-invasively during titration)
• Heart rate every 15–30 minutes
• Hourly urine output
• Serum potassium every 6–12 hours for prolonged infusions (>24 hours)
Post-Infusion:
• Monitor for rebound hypertension for 2–4 hours after discontinuation
• Reassess electrolytes before discharge from ICU
• Monitor for rebound hypertension for 2–4 hours after discontinuation
• Reassess electrolytes before discharge from ICU
BRANDS AVAILABLE IN INDIA
• Corlopam (Abbott/Pfizer)
• Fenopres (Samarth Life Sciences)
• Dopafen (La Renon Healthcare)
• Fenopres (Samarth Life Sciences)
• Dopafen (La Renon Healthcare)
PRICE RANGE (INR)
• ₹450–₹900 per ampoule (10 mg/mL concentration)
• NLEM status: Not included
• Availability: Primarily in tertiary care hospitals and ICU settings; not routinely stocked in peripheral centres
• Government supply: Limited availability
• NLEM status: Not included
• Availability: Primarily in tertiary care hospitals and ICU settings; not routinely stocked in peripheral centres
• Government supply: Limited availability
CLINICAL PEARLS
• Preferred IV antihypertensive in hypertensive emergencies with renal impairment — improves renal perfusion via DA1-mediated vasodilation
• Very short half-life (~5 minutes) allows precise titration; effect wears off rapidly upon discontinuation
• Reflex tachycardia is expected — avoid in patients with active coronary ischaemia or recent myocardial infarction
• Always check for sulphite allergy before administration; patients with asthma may have higher sulphite sensitivity
• Does not cause cyanide or thiocyanate toxicity — safer than sodium nitroprusside for prolonged infusions
• Not suitable for outpatient or ward-level use; requires ICU-level monitoring infrastructure
• Very short half-life (~5 minutes) allows precise titration; effect wears off rapidly upon discontinuation
• Reflex tachycardia is expected — avoid in patients with active coronary ischaemia or recent myocardial infarction
• Always check for sulphite allergy before administration; patients with asthma may have higher sulphite sensitivity
• Does not cause cyanide or thiocyanate toxicity — safer than sodium nitroprusside for prolonged infusions
• Not suitable for outpatient or ward-level use; requires ICU-level monitoring infrastructure
TAGS
fenoldopam; hypertensive-emergency; DA1-agonist; renal-protective; ICU-drug; intravenous-antihypertensive; critical-care; Schedule-H; reflex-tachycardia
VERSION
RxIndia v1.0 — 28 Feb 2026
REFERENCES
• CDSCO Approved Product Information
• Indian Pharmacopoeia
• API Textbook of Medicine
• ICMR Guidelines on Management of Hypertensive Emergencies
• AIIMS ICU Drug Protocols
• Goodman & Gilman’s The Pharmacological Basis of Therapeutics
• Harrison’s Principles of Internal Medicine
• Indian Pharmacopoeia
• API Textbook of Medicine
• ICMR Guidelines on Management of Hypertensive Emergencies
• AIIMS ICU Drug Protocols
• Goodman & Gilman’s The Pharmacological Basis of Therapeutics
• Harrison’s Principles of Internal Medicine
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Clinical Responsibility
This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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