Start ISUPREL injection at the lowest recommended dose and increase the rate of administration gradually if necessary while carefully monitoring the patient. The usual route of administration is by intravenous infusion or bolus intravenous injection. In dire emergencies, the drug may be administered by intracardiac injection. If time is not of the utmost importance, initial therapy by intramuscular or subcutaneous injection is preferred.
Recommended dosage for adults with heart block, Adams-Stokes attacks, and cardiac arrest:
Route of
Administration
Preparation of Dilution
Initial Dose
Subsequent
Dose Range*
Bolus
intravenous injection
Dilute 1 mL (0.2 mg) in 9 mL of Sodium Chloride Injection, USP, or 5% Dextrose Injection, USP
0.02 mg to 0.06 mg
(1 mL to 3 mL of diluted solution)
0.01 mg to 0.2 mg
(0.5 mL to 10 mL of diluted solution)
Intravenous
infusion
Dilute 10 mL (2 mg) in 500 mL of 5% Dextrose Injection, USP
5 mcg/min.
(1.25 mL of diluted solution per minute)
Intramuscular
Use Solution undiluted
0.2 mg (1 mL)
0.02 mg to 1 mg
(0.1 mL to 5 mL)
Subcutaneous
Use Solution undiluted
0.2 mg (1 mL)
0.15 mg to 0.2 mg
(0.75 mL to 1 mL)
Intracardiac
Use Solution undiluted
0.02 mg (0.1 mL)
* Subsequent dosage and method of administration depend on the ventricular rate and the rapidity with which the cardiac pacemaker can take over when the drug is gradually withdrawn.
There are no well-controlled studies in children to establish appropriate dosing; however, the American Heart Association recommends an initial infusion rate of 0.1 mcg/kg/min, with the usual range being 0.1 mcg/kg/min to 1 mcg/kg/min.
Recommended dosage for adults with shock and hypoperfusion states:
Route of Administration
Preparation of Dilution†
Infusion Rate††
Intravenous infusion
Dilute 5 mL (1 mg) in 500 mL of 5% Dextrose Injection, USP
0.5 mcg to 5 mcg per minute
(0.25 mL to 2.5 mL of diluted solution)
† Concentrations up to 10 times greater have been used when limitation of volume is essential.
†† Rates over 30 mcg per minute have been used in advanced stages of shock. The rate of infusion should be adjusted on the basis of heart rate, central venous pressure, systemic blood pressure, and urine flow. If the heart rate exceeds 110 beats per minute, it may be advisable to decrease or temporarily discontinue the infusion.
Recommended dosage for adults with bronchospasm occurring during anesthesia:
Route of
Administration
Preparation of Dilution
Initial Dose
Subsequent
Dose
Bolus
intravenous
injection
Dilute 1 mL (0.2 mg) in 9 mL of Sodium Chloride Injection, USP, or 5% Dextrose Injection, USP
0.01 mg to 0.02 mg
(0.5 mL to 1 mL of diluted solution)
The initial dose may be repeated when necessary
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Such solution should not be used.
