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Fenoldopam

Medically reviewed by Drugs.com. Last updated on Jul 27, 2020.

Pronunciation

(fe NOL doe pam)

Index Terms

  • Fenoldopam Mesylate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intravenous:

Corlopam: 10 mg/mL (1 mL [DSC]); 20 mg/2 mL (2 mL [DSC]) [contains propylene glycol, sodium metabisulfite]

Brand Names: U.S.

  • Corlopam [DSC]

Pharmacologic Category

  • Antihypertensive
  • Dopamine Agonist

Pharmacology

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

Distribution

Vd: 0.6 L/kg

Metabolism

Hepatic via methylation, glucuronidation, and sulfation; the 8-sulfate metabolite may have some activity; extensive first-pass effect

Excretion

Urine (90%); feces (10%); Clearance: Children: 3 L/hour/kg

Onset of Action

IV: Children: 5 minutes; Adults: 10 minutes; Note: Majority of effect of a given infusion rate is attained within 15 minutes.

Duration of Action

IV: 1 hour

Half-Life Elimination

IV: Children: 3 to 5 minutes; Adults: ~5 minutes

Use: Labeled Indications

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

Contraindications

There are no contraindications listed in the manufacturer’s labeling.

Dosing: Adult

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.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Severe hypertension: Infants, Children, and Adolescents: IV: Continuous IV infusion: Initial: 0.2 mcg/kg/minute; may be increased every 20 to 30 minutes to 0.3 to 0.5 mcg/kg/minute; maximum dose: 0.8 mcg/kg/minute (higher doses have been shown to worsen tachycardia without any additional blood pressure benefits) (AAP [Flynn 2017])

Reconstitution

Dilute with NS or D5W to a final concentration of 40 mcg/mL.

Administration

IV: For continuous IV infusion only.

Storage

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.

Drug Interactions

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 used at chemotherapy doses, hold blood pressure lowering medications for 24 hours before amifostine administration. If blood pressure lowering therapy cannot be held, do not administer amifostine. Use caution with radiotherapy doses of amifostine. 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

Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Monitor therapy

Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Monitor therapy

Bromperidol: Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. Avoid combination

Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive 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-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Monitor therapy

Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. 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

Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. 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

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined.

≥5%:

Cardiovascular: Flushing, hypotension

Central nervous system: Headache

Gastrointestinal: Nausea

<5%:

Cardiovascular: Angina pectoris, bradycardia, cardiac failure, chest pain, ECG abnormality (ST-T abnormalities), extrasystoles, inversion T wave on ECG, myocardial infarction, orthostatic hypotension, palpitations, tachycardia

Central nervous system: Anxiety, dizziness, insomnia

Dermatologic: Diaphoresis

Endocrine & metabolic: Hyperglycemia, hypokalemia, increased lactate dehydrogenase

Gastrointestinal: Abdominal distention, abdominal pain, constipation, diarrhea, vomiting

Genitourinary: Oliguria, urinary tract infection

Hematologic & oncologic: Hemorrhage, leukocytosis

Hepatic: Increased serum transaminases

Local: Injection site reaction

Neuromuscular & skeletal: Back pain, muscle cramps (limbs)

Ophthalmic: Increased intraocular pressure

Renal: Increased blood urea nitrogen, increased serum creatinine

Respiratory: Dyspnea, nasal congestion

Miscellaneous: Fever

Warnings/Precautions

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.

Monitoring Parameters

Blood pressure, heart rate, ECG; serum potassium concentrations

Pregnancy Considerations

Adverse events were not observed in animal reproduction studies. Fenoldopam was administered orally to rats and rabbits during the period of organogenesis; although maternal toxicity occurred at the highest dose, teratogenic or fetotoxic effects were not observed.

Severe maternal hypertension is associated with adverse pregnancy outcomes, including maternal stroke, pulmonary edema, myocardial ischemia, or maternal/fetal death.

Patient Education

What is this drug used for?

• It is used to treat high blood pressure.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Headache

• Flushing

• Nausea

• Injection site pain or irritation

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Low potassium like muscle pain or weakness, muscle cramps, or an abnormal heartbeat

• Fast heartbeat

• Severe dizziness

• Passing out

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine’s uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.