Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Corlopam: 10 mg/mL (1 mL); 20 mg/2 mL (2 mL) [contains propylene glycol, sodium metabisulfite]
Pharmacology
Mechanism of Action
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
Pharmacokinetics/Pharmacodynamics
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.
Dosage and Administration
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 amifostine is used at chemotherapy doses, blood pressure lowering medications should be withheld for 24 hours prior to amifostine administration. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. 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
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
Pregnancy Risk Factor
B
Pregnancy Considerations
Adverse events were not observed in animal reproduction studies.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience headache, flushing, nausea, or injection site pain or irritation. Have patient report immediately to prescriber signs of low potassium (muscle pain or weakness, muscle cramps, or an abnormal heartbeat), fast heartbeat, severe dizziness, or passing out (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
