Treatment of clinically important hypotension occurring in the setting of anesthesia.
Stimulates α1, β1, and β2 receptors, leading to vasoconstriction and an increased cardiac output, both of which contribute to an increased blood pressure. Also causes indirect adrenergic stimulation by causing release of norepinephrine from sympathetic nerves.
Increased blood pressure.
Absorption: IV administration results in complete bioavailability.
Distribution: Crosses the placenta.
Metabolism and Excretion: Metabolized into norephedrine. Primarily excreted in urine.
Half-life: 6 hr.
TIME/ACTION PROFILE (blood pressure elevation)
Use Cautiously in:
- OB: Use only if potential maternal benefit outweighs potential risks to fetus; can cause metabolic acidosis in newborn;
- Lactation: Use only if potential maternal benefit outweighs potential risks to child;
- Geri: More susceptible to adverse reactions; may require ↓ dose;
- Pedi: Safety and effectiveness not established.
Adverse Reactions/Side Effects
CNS: dizziness, restlessness
CV: bradycardia, hypertension, palpitations, tachycardia
GI: nausea, vomiting
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
- Concurrent use with oxytoxic medications, including methylergonovine or ergonovine can lead to significant postpartum hypertension; closely monitor blood pressure.
- Atropine, clonidine, MAO inhibitors, and propofol may augment effects on blood pressure; closely monitor blood pressure.
- α1 receptor antagonists, beta-blockers, reserpine, and quinidine can antagonize effects on blood pressure; closely monitor blood pressure.
- May ↓ effects of epidural anesthetics.
- Concurrent use with theophylline may ↑ risk of nausea, nervousness, and insomnia.
- Concurrent use with digoxin may ↑ risk of arrhythmias.
IV (Adults) 5–10 mg initially; may repeat dose as needed based on blood pressure (not to exceed maximum total dose = 50 mg).
Solution for injection (must be diluted): 50 mg/mL
- Monitor BP continuously during administration.
- Decreased cardiac output (Indications)
- IV Push: Dilute with 0.9% NaCl or D5W before injecting. Concentration: 5 mg/mL. Do not administer solutions that are discolored or contain particulate matter.
Advise patient to notify health care professional if pregnant or breast feeding before surgery.
Increase in BP.
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