Version August 2025
Note: Patients may exhibit dose-dependent vasodilation due to unopposed beta2-agonism elicited by isoproterenol.
Bradycardia; increase cardiac output: Very limited data available: Continuous IV infusion: 0.05 to 1 mcg/kg/minute; titrate to effect (Ref)
Note: Patients may exhibit dose-dependent vasodilation due to unopposed beta2-agonism elicited by isoproterenol.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Isoproterenol: Drug information")
Note: May cause dose-dependent hypotension due to beta-2 agonist effects.
Atrioventricular block, symptomatic and/or hemodynamically unstable:
Note: Should only be used as a temporizing measure until a permanent pacemaker can be placed, if clinically indicated. In most cases, pharmacologic agents will not be effective and temporary transcutaneous or transvenous pacing is necessary as a bridge to permanent pacemaker placement (Ref).
Continuous infusion: IV: Usual dosage range: 1 to 20 mcg/minute; initiate at the low end of the dosage range and titrate to clinical response (Ref).
Bradycardia, symptomatic and/or hemodynamically unstable (unresponsive to atropine) (off-label use): Continuous infusion: IV: Usual dosage range: 1 to 20 mcg/minute; initiate at the low end of the dosage range and titrate to clinical response (Ref).
Cardiogenic shock due to bradycardia (off-label use): Continuous infusion: IV: 2 to 20 mcg/minute (Ref).
Provocation during tilt table testing, diagnostic agent for syncope (off-label use): Note: Timing of initiation and dose adjustment during test may be institution specific; refer to institutional protocols.
Continuous infusion: IV: Initial: 1 mcg/minute; increase as necessary based on clinical response up to 3 mcg/minute (Ref).
Torsade de pointes, to reduce recurrence (off-label use):
Note: For use only in patients who have a bradycardia-mediated cause of torsades de pointes. Avoid use in congenital long QT syndrome. Patient should be under the care of a clinician experienced with using isoproterenol for this condition (Ref).
Continuous infusion: IV: Usual dosage range: 2 to 10 mcg/minute; titrate to clinical response (Ref).
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Postmarketing:
Cardiovascular: Adams-Stokes syndrome, angina pectoris, atrioventricular block (Barold 2015), bradycardia (Duong 2020), chest pain (Duong 2020), coronary artery vasospasm (Duong 2020), flushing, hypertension, hypotension (Suwa 2004), increased ST segment on ECG (Okuya 2021), palpitations, tachyarrhythmia, tachycardia, ventricular arrhythmia (including non-sustained ventricular fibrillation) (Okuya 2021), ventricular premature contractions (Okuya 2021)
Dermatologic: Diaphoresis, pallor
Gastrointestinal: Nausea
Nervous system: Dizziness, headache, nervousness, tremor
Ophthalmic: Blurred vision (Duong 2020)
Respiratory: Dyspnea, pulmonary edema
Angina, preexisting ventricular arrhythmias, tachycardia or tachyarrhythmias; cardiac glycoside intoxication induced heart block or tachycardia.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, coronary artery disease); may increase myocardial oxygen demand resulting in ischemia.
• Diabetes: Use with caution in patients with diabetes mellitus; may transiently increase blood glucose levels.
• Distributive shock: Avoid use in patients with distributive shock; may reduce systemic vascular resistance (SVR) further resulting in hemodynamic compromise.
Special populations:
• Older patients: Use with caution in older patients.
Dosage form specific issues:
• Sulfites: Contains sulfites; may cause allergic reaction in susceptible individuals.
Other warnings/precautions:
• Appropriate use: Use with extreme caution; not currently a treatment of choice. Excessive or prolonged use may result in decreased effectiveness.
Isoproterenol is not recommended for treatment of bronchospasm. In children with refractory asthma, continuous isoproterenol infusion was associated with myocardial necrosis, congestive heart failure, further clinical deterioration, and death in some cases. The risk of cardiac toxicity was observed to be increased by concomitant corticosteroids or methylxanthines, acidosis, or hypoxemia; monitor patients closely (vital signs, ECG, cardiac enzymes) with therapy.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution, Injection, as hydrochloride:
Isuprel: 0.2 mg/mL (1 mL [DSC], 5 mL [DSC]) [contains disodium edta]
Generic: 0.2 mg/mL (1 mL, 5 mL)
Solution, Injection, as hydrochloride [preservative free]:
Generic: 0.2 mg/mL (1 mL, 5 mL)
Yes
Solution (Isoproterenol HCl Injection)
0.2 mg/mL (per mL): $16.80 - $130.80
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Injection, as hydrochloride:
Generic: 0.2 mg/mL (1 mL, 5 mL)
Parenteral: Administer by continuous IV infusion; requires the use of an infusion pump
IV: IV infusion administration requires the use of an infusion pump.
IV infusion: 20 mcg/mL
Store intact vials/ampules at 20°C to 25°C (68°F to 77°F). Protect from light; keep in opaque container until used. Exposure to air, light, or increased temperature may cause a pink to brownish pink color to develop. Solutions should not be used if they are discolored or contain a precipitate. Stability of parenteral admixture in NS or D5W at room temperature (25°C [77°F]) or at refrigeration (4°C [39°F]) for ≥24 hours has been reported (Newton 1981; van Matre 2023); also refer to institution-specific policies and procedures.
Mild or transient episodes of heart block that do not require electric shock or pacemaker therapy; serious episodes of heart block and Adams-Stokes attacks (except when caused by ventricular tachycardia or fibrillation); cardiac arrest until electric shock or pacemaker therapy is available; bronchospasm during anesthesia; adjunct to fluid and electrolyte replacement therapy and other drugs and procedures in the treatment of hypovolemic or septic shock and low cardiac output states (eg, decompensated heart failure, cardiogenic shock) (All indications: FDA approved in adults)
Note: The use of isoproterenol in advanced cardiac life support (ACLS) has largely been supplanted by the use of other adrenergic agents (eg, epinephrine and dopamine). The use of isoproterenol for bronchospasm during anesthesia and cardiogenic, hypovolemic, or septic shock is no longer recommended.
Isuprel may be confused with Disophrol, Isordil
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drug classes (antiarrhythmic agent, IV) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Acute Care Settings).
Substrate of COMT;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Beta-Blockers: May decrease therapeutic effects of Isoproterenol. Risk C: Monitor
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Chlorpheniramine: May increase therapeutic effects of Isoproterenol. Risk C: Monitor
Cocaine (Topical): May increase hypertensive effects of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider Therapy Modification
COMT Inhibitors: May increase serum concentration of COMT Substrates. Risk C: Monitor
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
DiphenhydrAMINE (Systemic): May increase therapeutic effects of Isoproterenol. Risk C: Monitor
Doxofylline: Sympathomimetics may increase adverse/toxic effects of Doxofylline. Risk C: Monitor
EPINEPHrine (Systemic): Isoproterenol may increase therapeutic effects of EPINEPHrine (Systemic). Risk X: Avoid
Esketamine (Injection): May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for elevated heart rate, hypertension, and arrhythmias may be increased. Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Hexoprenaline: May increase adverse/toxic effects of Isoproterenol. Risk X: Avoid
Inhalational Anesthetics: May increase arrhythmogenic effects of Isoproterenol. Risk X: Avoid
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Levothyroxine: May increase therapeutic effects of Isoproterenol. Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Monoamine Oxidase Inhibitors: May increase therapeutic effects of Isoproterenol. Risk C: Monitor
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Theophylline Derivatives: Isoproterenol may decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Animal reproduction studies have not been conducted by the manufacturer. Use of isoproterenol may interfere with uterine contractions at term (Mahon 1967).
Heart rate, blood pressure, respiratory rate, arterial blood gases, central venous pressure, ECG, urine output; in pediatric patients, daily cardiac enzymes
Stimulates beta1- and beta2-receptors resulting in relaxation of bronchial, GI, and uterine smooth muscle, increased heart rate and contractility, vasodilation of peripheral vasculature
Onset of action: IV: Immediate
Duration: IV: 10-15 minutes
Metabolism: Via conjugation in many tissues including hepatic and pulmonary
Half-life elimination: 2.5-5 minutes
Excretion: Urine (primarily as sulfate conjugates)
