Usual Adult Dose for Atrial Fibrillation

This drug is administered by continuous IV infusion (with or without a loading dose); additional loading doses and/or titration of the maintenance infusion may be necessary based on desired ventricular response:

Recommended Dosing:
Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV

• Maintenance dose: 25 to 200 mcg/kg/min IV
• Maximum dose: 200 mcg/kg/min IV
• Duration: Maintenance infusions may be continued for up to 48 hours

Comment:

• In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

Use: For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable; it is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention

Usual Adult Dose for Atrial Flutter

This drug is administered by continuous IV infusion (with or without a loading dose); additional loading doses and/or titration of the maintenance infusion may be necessary based on desired ventricular response:

Recommended Dosing:
Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV

• Maintenance dose: 25 to 200 mcg/kg/min IV
• Maximum dose: 200 mcg/kg/min IV
• Duration: Maintenance infusions may be continued for up to 48 hours

Comment:

• In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

Use: For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable; it is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention

Usual Adult Dose for Supraventricular Tachycardia

This drug is administered by continuous IV infusion (with or without a loading dose); additional loading doses and/or titration of the maintenance infusion may be necessary based on desired ventricular response:

Recommended Dosing:
Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV

• Maintenance dose: 25 to 200 mcg/kg/min IV
• Maximum dose: 200 mcg/kg/min IV
• Duration: Maintenance infusions may be continued for up to 48 hours

Comment:

• In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

Use: For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable; it is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention

Usual Adult Dose for Intra- or Post-op SVT or Hypertension

For intraoperative and postoperative tachycardia and hypertension it is not always advisable to slowly titrate to a therapeutic effect; therefore 2 dosing options are presented (immediate control and gradual control):

IMMEDIATE CONTROL:

• Administer 1 mg/kg IV as a bolus dose over 30 seconds followed by 150 mcg/kg/min if needed
• Adjust the infusion rate as required to maintain desired heart rate and blood pressure (refer to maximum recommended doses)

GRADUAL CONTROL:

• Administer 500 mcg/kg IV as a bolus dose over 1 minute followed by a maintenance infusion of 50 mcg/kg/min IV for 4 minutes
• Infusion may be continued at 50 mcg/kg/min or, if the response is inadequate, titrated upward in 50 mcg/kg/min increments (increased no more frequently than every 4 minutes) to a maximum of 300 mcg/kg/min; may administer an optional loading dose equal to the initial bolus (500 mcg/kg over 1 minute) prior to each increase in infusion rate

MAXIMUM RECOMMENDED DOSES:

• For the treatment of tachycardia, maintenance infusion dosages greater than 200 mcg/kg/min IV are not recommended; dosages greater than 200 mcg/kg/min IV provide little additional heart rate-lowering effect, and the rate of adverse reactions increases.
• For the treatment of hypertension, higher maintenance infusion dosages (250 to 300 mcg/kg/min) may be required; the safety of doses above 300 mcg/kg/min has not been studied.

Use: For the short-term treatment of tachycardia and hypertension that occur during induction and tracheal intubation, during surgery, on emergence from anesthesia and in the postoperative period, when such specific intervention is considered indicated

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Use with caution.

Dose Adjustments

After patients achieve adequate control of the heart rate and a stable status, they may be transitioned to alternative antiarrhythmic drugs. When transitioning alternative drugs, the physician should carefully consider the labeling instructions of the alternative drug selected and reduce the dosage of this drug as follows:

• Thirty minutes following the first dose of the alternative drug, reduce the infusion rate 50%.
• After administration of the second dose of the alternative drug, monitor patient response and if satisfactory control is maintained for the first hour, discontinue the infusion.

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• If a local infusion site reaction develops, an alternative infusion site should be used and caution should be taken to prevent extravasation.
• It is advised to terminate the infusion gradually because of the risk of rebound tachycardia and rebound hypertension.

Storage requirements:

• Consult the manufacturer product labeling.

• IV compatibility:
• Consult the manufacturer product labeling.

General:

• Following a dosage reduction or discontinuation of this drug, adverse reactions should resolve within 30 minutes.
• Caution is recommended when discontinuing infusions abruptly in coronary artery disease patients.
• As with all beta-blockers, withdrawal effects cannot be excluded.

Monitoring:

• Cardiovascular: Blood pressure; heart rate