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Authoritative Clinical Reference
| Parameter | Recommendation |
|
Starting dose
|
5 mcg IV bolus (slow injection over 1 minute) |
|
Titration
|
Repeat 5 mcg bolus every 2–3 minutes if inadequate response; then commence infusion |
|
Usual maintenance dose
|
0.5–10 mcg/min IV infusion |
|
Maximum dose
|
10 mcg/min (rarely exceeding this) |
| Parameter | Recommendation |
|
Starting dose
|
0.01–0.02 mcg/kg/min IV infusion |
|
Titration
|
Increase by 0.01 mcg/kg/min every 10–15 minutes based on heart rate response |
|
Usual maintenance dose
|
0.03–0.10 mcg/kg/min |
|
Maximum dose
|
0.20 mcg/kg/min |
| Parameter | Recommendation |
|
Starting dose
|
1–2 mcg/min IV infusion |
|
Titration
|
Increase by 1–2 mcg/min every 5–10 minutes to shorten QT interval |
|
Usual maintenance dose
|
2–10 mcg/min |
|
Maximum dose
|
10 mcg/min |
| Parameter | Recommendation |
|
Starting dose
|
1 mcg/min IV infusion |
|
Titration
|
Increase based on clinical response |
|
Usual maintenance dose
|
1–5 mcg/min |
|
Maximum dose
|
10 mcg/min |
| Indication | Dosing | Duration | Notes |
|
Septic shock with bradycardia unresponsive to other agents — OFF-LABEL
|
Starting dose: 1 mcg/min IV; Titration: Increase by 1–2 mcg/min every 10 min; Usual range: 1–10 mcg/min; Maximum: 10 mcg/min | Short-term bridge while alternative measures instituted | Specialist only. Used when bradycardia limits norepinephrine therapy. Evidence basis: Case series; Indian critical care practice |
| Age Group | Starting Dose | Titration | Usual Maintenance | Maximum Dose |
|
Neonates
|
0.02–0.05 mcg/kg/min IV | Increase by 0.01–0.02 mcg/kg/min every 10–15 min | 0.05–0.20 mcg/kg/min | 0.30 mcg/kg/min |
|
Infants (1 month – 1 year)
|
0.02–0.05 mcg/kg/min IV | Increase by 0.01–0.02 mcg/kg/min every 10–15 min | 0.05–0.15 mcg/kg/min | 0.20 mcg/kg/min |
|
Children (1–12 years)
|
0.02–0.05 mcg/kg/min IV | Increase by 0.01–0.02 mcg/kg/min every 10–15 min | 0.05–0.15 mcg/kg/min | 0.20 mcg/kg/min |
|
Adolescents (>12 years)
|
5 mcg IV bolus OR 0.02 mcg/kg/min IV infusion | As per adult protocol | 0.5–10 mcg/min OR 0.03–0.10 mcg/kg/min | 10 mcg/min |
| Indication | Details |
|
Paediatric Torsades de Pointes — OFF-LABEL
|
Specialist only; same weight-based dosing as above; not first-line (magnesium and pacing preferred). Limited evidence in paediatric population. |
| Renal Function | Recommendation |
| Mild–Moderate impairment (eGFR 30–89 mL/min) | No dosage adjustment required |
| Severe impairment (eGFR <30 mL/min) | No dose adjustment; use with caution due to altered volume of distribution |
| Haemodialysis | No specific data; not significantly dialysed; dose as per clinical response |
| Child-Pugh Class | Score | Recommendation |
|
Class A (Mild)
|
5–6 points | No dose adjustment required |
|
Class B (Moderate)
|
7–9 points | No dose adjustment required; monitor closely for adverse effects |
|
Class C (Severe)
|
10–15 points | Use with caution; start at lower infusion rate; titrate cautiously; limited data available |
| Aspect | Details |
|
Overall safety
|
Limited human data; not formally assigned risk category; use only when clearly indicated |
|
When to use
|
Emergency situations (life-threatening bradycardia) where no safer alternatives are effective |
|
Preferred alternatives
|
Atropine (for vagal-mediated bradycardia); dopamine or dobutamine (for haemodynamic support) |
|
Monitoring required
|
Maternal: HR, BP, ECG. Fetal: Continuous fetal heart rate monitoring; assess uterine perfusion |
| Aspect | Details |
|
Compatibility
|
Likely compatible — short half-life, low systemic exposure with controlled infusion |
|
Expected levels in milk
|
Low (minimal transfer expected) |
|
Preferred alternatives
|
Based on indication; avoid routine outpatient use |
|
Infant monitoring
|
Irritability, tachycardia, feeding difficulties (though risk is low) |
| Aspect | Recommendation |
|
Starting dose
|
0.01 mcg/kg/min IV (lower end of range) |
|
Titration
|
Slower titration advised — increase every 15–20 minutes rather than 10 minutes |
|
Extra risks
|
Reduced beta-receptor responsiveness; increased risk of tachyarrhythmias; underlying ischaemic heart disease may be unmasked; orthostatic hypotension due to peripheral vasodilation |
|
Monitoring
|
More frequent ECG and BP monitoring; watch for angina symptoms |
| Interacting Drug | Effect/Risk | Management |
|
MAO inhibitors (phenelzine, tranylcypromine, linezolid)
|
Severe potentiation of cardiovascular effects; risk of hypertensive crisis and arrhythmias | AVOID combination; if unavoidable, use significantly reduced doses with intensive monitoring |
|
Beta-blockers (propranolol, metoprolol, carvedilol)
|
Antagonistic effect — blunts isoproterenol response | Discontinue beta-blocker if isoproterenol therapy essential; select cardioselective agent if must continue |
|
Halogenated general anaesthetics (halothane, enflurane, isoflurane)
|
Increased risk of ventricular arrhythmias due to myocardial sensitisation to catecholamines | Avoid combination or use extreme caution; consider alternative anaesthetics |
|
Tricyclic antidepressants (amitriptyline, imipramine)
|
Potentiated cardiovascular effects | Avoid combination or use with extreme caution |
| Interacting Drug | Effect/Risk | Management |
|
Digoxin
|
Increased risk of arrhythmias (both drugs affect cardiac conduction) | Monitor ECG closely; watch for ectopic beats |
|
Diuretics (furosemide, thiazides)
|
Risk of hypokalaemia-induced arrhythmias | Monitor serum potassium; supplement as needed |
|
Corticosteroids (systemic)
|
May potentiate hypokalaemia | Monitor electrolytes with prolonged co-administration |
|
Other adrenergic agonists (adrenaline, dopamine, dobutamine)
|
Additive cardiovascular effects — risk of severe hypertension, tachycardia, arrhythmias | Avoid concurrent use if possible; if essential, use reduced doses with enhanced monitoring |
|
Theophylline/aminophylline
|
Additive cardiac stimulation | Monitor heart rate and rhythm |
| Adverse Effect | Notes |
| Ventricular arrhythmias (VT/VF) | May require immediate drug cessation and antiarrhythmic therapy |
| Angina pectoris / Myocardial infarction | In patients with underlying CAD; discontinue immediately |
| Severe hypotension | Paradoxical effect due to peripheral β2-mediated vasodilation; may require volume support |
| Hypertensive crisis | Rare; if overdosed or with MAOIs |
| Severe hypokalaemia | Especially with high-dose or prolonged infusions; may precipitate arrhythmias |
| Pulmonary oedema | Rare; in patients with underlying cardiac dysfunction |
| Timing | Parameters |
|
Baseline
|
12-lead ECG; serum electrolytes (K+, Mg2+); renal function; volume status assessment; cardiac history review |
|
During initiation/titration
|
Continuous ECG monitoring; blood pressure and heart rate every 5–15 minutes; SpO2; urine output |
|
During maintenance infusion
|
Continuous ECG; BP and HR hourly once stable; serum potassium every 6–12 hours in prolonged infusions |
|
Long-term (ICU settings)
|
Monitor for tachyphylaxis; daily electrolytes; assess need for weaning; evaluate for definitive therapy (pacing) |
| Formulation | Price Range | Notes |
| 0.2 mg/mL (1 mL ampoule) | ₹30–₹70 per ampoule | Brand-dependent |
| 1 mg/5 mL vial | ₹100–₹200 per vial | Less commonly stocked |
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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