Vasopressors and inotropes
Isoproterenol (Isuprel) drip
Isuprel
Dosing
| Start | 2 mcg/min |
|---|---|
| Titrate | To heart rate, every 5–10 minutes |
| Maximum | About 10–20 mcg/min |
| Common bags | 1 mg in 250 mL (4 mcg/mL); 2 mg in 250 mL (8 mcg/mL) |
| Dose units | mcg/min |
Line and administration
- Peripheral or central
Watch for
- Tachyarrhythmias and myocardial ischemia
- Vasodilation can drop blood pressure
- Used for bradycardia, heart block bridging and torsades
Isoproterenol: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Heart FailureAdvanced HF: shock bridge, MCS, transplant and palliative care: A peak VO₂ ≤12 mL/kg/min on a β-blocker supports transplant listing (ISHLT 2016), and median survival after transplant is about 12.5 years (ISHLT registry, 2002–2009 era). The denervated heart rests at 90–110 bpm, does not respond to atropine (use isoproterenol, epinephrine or pacing), needs a reduced adenosine dose, and develops allo
- Rhythm GalleryVentricular rhythms and wide-complex tachycardia: Torsades is polymorphic VT twisting around the baseline on a long QT, typically started by a short–long–short sequence. Risk rises with QTc over 500 ms, female sex, bradycardia, low K⁺ or Mg²⁺, heart failure and QT drugs (class IA and III antiarrhythmics, haloperidol, ondansetron, macrolides, fluoroquinolones, methadone). Sustained polymorphic VT g
- Temporary PacingIndications and the 2018 ACC/AHA/HRS guideline: Drugs: atropine IIa for SND and AV-nodal block, including in acute MI; beta agonists (isoproterenol, dopamine, dobutamine, epinephrine) IIb when ischemia is unlikely; aminophylline IIb in inferior MI, IIa after heart transplant or spinal cord injury; atropine after heart transplant III: Harm.
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Other vasopressors and inotropes
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.