NEODOSE

INDICATIONS

• Hypotension.Treatment of hypoperfusion and hypotension, specially if related to myocardial dysfunction.
• Severe Sepsis and Septic Shock:

• There was no difference between epinephrine and dopamine for fluid-refractory septic shock in a randomized, double-blind controlled trial (n=40) in India; however, the study was underpowered. After persistent shock despite 2 boluses of normal saline 10 mL/kg, epinephrine 0.2 mcg/kg/min or dopamine 10 mcg/kg/min were started. Doses were increased, if needed, after 15 minutes to epinephrine 0.3 mcg/kg/min or dopamine 15 mcg/kg/min; then again, if needed, after another 15 minutes to epinephrine 0.4 mcg/kg/min or dopamine 20 mcg/kg/min. The mean gestational age was 30.3 weeks (1.1 kg birth weight) for epinephrine group and 30.7 weeks (1.181 kg birth weight) for dopamine group.

ADVERSE EFFECTS

Tachycardia and arrhythmias. May increase pulmonary artery pressure. Reversible suppression of prolactin and thyrotropin secretion.

BLACK BOX WARNING

Tissue sloughing may occur with IV infiltration. According to the manufacturer’s BLACK BOX WARNING, to prevent sloughing and necrosis in areas of extravasation, the area should be infiltrated as soon as possible with a saline solution containing phentolamine mesylate. Suggested treatment for extravasation: Inject a 0.5 mg/mL solution of phentolamine into the affected area. The usual amount needed is 1 to 5 mL, depending on the size of the infiltrate.

ADMINISTRATION

May administer by IV or IO route as a continuous infusion. Avoid bolus administration of the drug. Infusion into a large vein is preferred to minimize risk of tissue extravasation. Vials must be diluted prior to use in compatible diluent up to a concentration of 3200 mcg/mL. The recommended standard neonate concentration is 1600 mcg/mL.

Solution Preparation Calculations

MONITORING

Continuous heart rate and intra-arterial blood pressure monitoring is preferable. Assess urine output and peripheral perfusion frequently. Observe IV site closely for blanching and infiltration.