Corlopam (fenoldopam mesylate) for Emergency Reduction of Blood Pressure

What is Corlopam, and how does it work?

Corlopam (fenoldopam mesylate) Injection is a dopamine receptor agonist (vasodilator) used for in-hospital, short-term (up to 48 hours) management of severe high blood pressure (hypertension) when rapid, but quickly reversible, emergency reduction of blood pressure is indicated. Corlopam is available in generic form.

What are the side effects of Corlopam?

Common side effects of Corlopam include

• headache,
• flushing (warmth, redness, or tingly feeling, particularly in the face and neck),
• nausea,
• low blood pressure (hypotension),
• fast heartbeat, and
• low blood
  potassium.

What is the dosage for Corlopam?

Recommended Dosage

Adult Patients

• Initiate dosing at 0.01 to 0.3 mcg/kg/min as a continuous intravenous
  infusion.
• Dosing may be increased in increments of 0.05 to 0.1 mcg/kg/minute every
  15 minutes or longer, until target blood pressure is reached; the maximal infusion rate reported in clinical studies was 1.6 mcg/kg/minute.
• Doses lower than 0.1 mcg/kg/min and slow up-titration have been associated with less reflex tachycardia.
• Maintenance infusions may be continued for up to 48 hours.
• Oral antihypertensive agents can be added during fenoldopam infusion or after discontinuation.

Pediatric Patients

• Initiate dosing at 0.2 mcg/kg/minute and titrate dose by 0.3 to 0.5 mcg/kg/min every 20-30 minutes to a maximum dose of 0.8 mcg/kg/minute.
• Higher doses generally produced no further decreases in MAP but did worsen tachycardia.

Preparation And Administration

• Dilute contents of ampules or vials with 0.9% Sodium Chloride Injection or 5% Dextrose in Water before infusion.
• Each ampule or vial is for single use only. Discard diluted solution if not being administered to a patient after 4 hours at room temperature or 24 hours at refrigerated temperature.
• Inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit.
• If particulate matter or cloudiness is observed, discard the drug.

Table 1: Dilution Instructions for Adults

mL of Concentrate (mg of drug)Added toFinal Concentration4 mL (40 mg)1000 mL40 mcg/mL2 mL (20 mg)500 mL40 mcg/mL1 mL (10 mg)250 mL40 mcg/mL

Table 2: Dilution Instructions for Pediatric Patients

mL of Concentrate (mg of drug)Added toFinal Concentration3 mL (30 mg)500 mL60 mcg/mL1.5 mL (15 mg)250 mL60 mcg/mL0.6 mL (6 mg)100 mL60 mcg/mL

Rates of infusion in mL/hour for fenoldopam may be calculated using the following formula:

Infusion Rate (mL/h) =[Dose (mcg/kg/min) x Weight (kg) x 60 min/h]
Concentration (mcg/mL)

Example calculations for infusion rates are as follows:

Example 1: for a 60 kg patient at an initial dose of 0.01 mcg/kg/min using a 40 mcg/mL concentration, the infusion rate would be as follows:

Infusion Rate (mL/h) =[0.01 (mcg/kg/min) x 60 (kg) x 60 (min/h)] = 0.9 (mL/h)
40 (mcg/mL)

Example 2: for a 10 kg patient at a dose of 0.2 mcg/kg/min using a 60 mcg/mL concentration, the infusion rate would be as follows:

Infusion Rate (mL/h) =[0.2 (mcg/kg/min) x 10 (kg) x 60 (min/h)] = 2.0 (mL/h)
60 (mcg/mL)

QUESTION

Salt and sodium are the same.
See Answer

What drugs interact with Corlopam?

Beta-Blockers

• Avoid concomitant use of fenoldopam with beta-blockers.
• If the drugs are used together, blood pressure should be monitored frequently because hypotension could result from beta-blocker inhibition of the sympathetic reflex response to fenoldopam.

Is Corlopam safe to use while pregnant or breastfeeding?

• Studies have revealed maternal toxicity at the highest doses tested but no evidence of impaired fertility or harm to the fetus due to fenoldopam.
• There are, however, no adequate and well-controlled studies in pregnant women.
• Fenoldopam is excreted in milk in rats. It is not known whether this drug is excreted in human milk.
• Because many drugs are excreted in human milk, discontinue nursing or fenoldopam.