(fe NOL doe pam)
Severe hypertension: Short-term treatment of severe hypertension (up to 48 hours in adults while in hospital), including patients with malignant hypertension with deteriorating end-organ function; short-term (up to 4 hours while in hospital) blood pressure reduction in pediatric patients while in hospital
There are no contraindications listed in the manufacturer 's labeling.
Severe hypertension: IV: Initial: 0.01 to 0.3 mcg/kg/minute; may increase in increments of 0.05 to 0.1 mcg/kg/minute every 15 minutes until target blood pressure is reached; the maximum infusion rate reported in clinical studies was 1.6 mcg/kg/minute; limit for short-term use (up to 48 hours)
Note: Oral antihypertensive agents may be added during fenoldopam infusion or after discontinuation.
Refer to adult dosing.
Severe hypertension: IV: Initial: 0.2 mcg/kg/minute; may increase in increments of 0.3 to 0.5 mcg/kg/minute every 20 to 30 minutes (maximum dose: 0.8 mcg/kg/minute); limit for short-term (4 hours) use
Note: Oral antihypertensive agents may be added during fenoldopam infusion or after discontinuation.
There are no dosage adjustments provided in the manufacturer 's labeling; the effects of hemodialysis have not been evaluated.
There are no dosage adjustments provided in the manufacturer 's labeling.
Dilute with NS or D5W to a final concentration of 40 mcg/mL (adults) or 60 mcg/mL (pediatric).
For continuous IV infusion only.
Store undiluted product at 2 ‚ °C to 30 ‚ °C (35 ‚ °F to 86 ‚ °F). Diluted solutions in NS or D5W that have been prepared but not administered should be discarded after 4 hours at room temperature or 24 hours refrigerated.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Corlopam: 10 mg/mL (1 mL); 20 mg/2 mL (2 mL) [contains propylene glycol, sodium metabisulfite]
Generic: 10 mg/mL (1 mL); 20 mg/2 mL (2 mL)
Stable with NS or D5W.
Y-site administration: Incompatible with aminophylline, amphotericin B, ampicillin, bumetanide, cefoxitin, dexamethasone sodium phosphate, diazepam, fosphenytoin, furosemide, ketorolac, methohexital, methylprednisolone sodium succinate, pentobarbital, phenytoin, prochlorperazine edisylate, sodium bicarbonate, thiopental.
Compatibility in syringe: Incompatible with ceftriaxone.
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Amifostine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Amifostine. Management: When amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consider therapy modification
Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Monitor therapy
Herbs (Hypertensive Properties): May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy
Herbs (Hypotensive Properties): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Monitor therapy
Levodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa. Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Monitor therapy
Obinutuzumab: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy
Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Monitor therapy
Blood pressure, heart rate, ECG; serum potassium concentrations
≥5%:
Cardiovascular: Cutaneous flushing, hypotension
Central nervous system: Headache
Gastrointestinal: Nausea
<5%:
Cardiovascular: Angina, bradycardia, chest pain, extrasystoles, heart failure, MI, orthostatic hypotension, palpitation, ST-T abnormalities, T-wave inversion, tachycardia
Central nervous system: Anxiety, dizziness, fever, insomnia
Endocrine & metabolic: Hyperglycemia, hypokalemia, LDH increased
Gastrointestinal: Abdominal pain/fullness, constipation, diarrhea, vomiting
Genitourinary: Urinary tract infection
Hematologic: Bleeding, leukocytosis
Hepatic: Transaminases increased
Local: Injection site reactions
Neuromuscular & skeletal: Back pain, limb cramps
Ocular: Intraocular pressure increased
Renal: BUN increased, creatinine increased, oliguria
Respiratory: Dyspnea, nasal congestion
Miscellaneous: Diaphoresis
Concerns related to adverse effects:
- Hypokalemia: Hypokalemia has been observed within 6 hours of fenoldopam infusion; monitor potassium concentrations appropriately.
- Tachycardia: Dose-related tachycardia can occur, especially at infusion rates >0.1 mcg/kg/minute (adults) and >0.8 mcg/kg/minute (pediatric). Doses lower than 0.1 mcg/kg/minute and slow up-titration is associated with less reflex tachycardia.
Disease-related concerns:
- Angina: Use with extreme caution in patients with obstructive coronary disease or ongoing angina pectoris; can increase myocardial oxygen demand due to tachycardia leading to angina pectoris.
- Glaucoma: Dose-dependent increase in intraocular pressure (IOP) has been reported in patients with glaucoma or intraocular hypertension; upon discontinuation, IOP returned to baseline within 2 hours.
Dosage form specific issues:
- Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).
- Sulfites: Contains sulfites; may cause allergic-type reactions, including anaphylactic symptoms and life-threatening or less severe asthmatic episodes, in susceptible individuals. Sulfite sensitivity is seen more frequently in asthmatic than in nonasthmatic people.
B
Fetal harm was not observed in animal studies; however, safety and efficacy have not been established for use during pregnancy. Use during pregnancy only if clearly needed.
A selective postsynaptic dopamine agonist (D1-receptors) which exerts hypotensive effects by decreasing peripheral vasculature resistance with increased renal blood flow, diuresis, and natriuresis; 6 times as potent as dopamine in producing renal vasodilatation; has minimal adrenergic effects
Vd: 0.6 L/kg
Hepatic via methylation, glucuronidation, and sulfation; the 8-sulfate metabolite may have some activity; extensive first-pass effect
Urine (90%); feces (10%); Clearance: Children: 3 L/hour/kg
IV: Children: 5 minutes; Adults: 10 minutes; Note: Majority of effect of a given infusion rate is attained within 15 minutes.
IV: 1 hour
IV: Children: 3 to 5 minutes; Adults: ~5 minutes
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience headache, flushing, nausea, or injection site pain or irritation. Have patient report immediately to prescriber signs of low potassium (muscle pain or weakness, muscle cramps, or an abnormal heartbeat), tachycardia, severe dizziness, or passing out (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.