Version December 2023
Hypertensive emergency:
Note: In general, reduce mean arterial blood pressure gradually by ~10% to 20% over the first hour, then by an additional 5% to 15% over the next 23 hours. Invasive blood pressure monitoring is recommended for appropriate dose titration (ACC/AHA [Whelton 2018]; Elliot 2022).
Continuous IV infusion: Initial: 0.1 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; usual initial dosing range: 0.01 to 0.3 mcg/kg/minute; maximum dose: 1.6 mcg/kg/minute; limit use to 48 hours (Panacek 1995; Tumlin 2000; manufacturer’s labeling).
There are no dosage adjustments provided in the manufacturer’s labeling; the effects of hemodialysis have not been evaluated.
There are no dosage adjustments provided in the manufacturer’s labeling.
Refer to adult dosing.
(For additional information see "Fenoldopam: Pediatric drug information")
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]).
All patients: There are no dosage adjustments provided in the manufacturer’s labeling; the effects of hemodialysis have not been evaluated.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Gastrointestinal: Nausea (12%)
Nervous system: Headache (24%)
1% to 10%:
Cardiovascular: Acute myocardial infarction (≤5%), angina pectoris (≤5%), chest pain (≤5%), extrasystoles (≤5%), flushing (>5%), heart failure (≤5%), hypotension (>5%), inversion T wave on ECG (6%), ischemic heart disease (≤5%), palpitations (≤5%), tachycardia (≤5%)
Dermatologic: Hyperhidrosis (≤5%)
Endocrine & metabolic: Hypokalemia (≤5%), increased lactate dehydrogenase (≤5%), increased serum glucose (≤5%)
Gastrointestinal: Abdominal pain (≤5%), vomiting (6%)
Genitourinary: Oliguria (≤5%)
Hepatic: Increased serum transaminases (≤5%)
Local: Injection-site reaction (7%)
Nervous system: Anxiety (≤5%), dizziness (≤5%), insomnia (≤5%), nervousness (≤5%)
Neuromuscular & skeletal: Muscle spasm (≤5%)
Renal: Increased blood urea nitrogen (≤5%), increased serum creatinine (≤5%)
Miscellaneous: Fever (≤5%)
Frequency not defined: Ophthalmic: Increased intraocular pressure
Postmarketing:
Cardiovascular: Cardiogenic shock, depression of ST segment on ECG
Gastrointestinal: Abdominal distention
Respiratory: Oxygen saturation decreased
There are no contraindications listed in the manufacturer’s labeling.
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.
A dose related tachycardia can occur, especially at infusion rates >0.1 mcg/kg/minute; in pediatric patients at doses >0.8 mcg/kg/minute, tachycardia has been shown to persist for at least 4 hours. Close monitoring of blood pressure is necessary; hypotension can occur.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP, 1997; Shehab, 2009).
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]
No
Solution (Corlopam Intravenous)
10 mg/mL (per mL): $597.48
20 mg/2 mL (per mL): $597.49
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IV: For continuous IV infusion only.
Continuous IV infusion: Administer using an infusion pump
IV infusion: 10 mg in 250 mL (concentration: 40 mcg/mL) of D5W or NS
IV infusion: 60 mcg/mL
Hypertensive emergency: Short-term treatment of hypertensive emergency (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) BP reduction in pediatric patients while in hospital.
None known.
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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: 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. Risk D: Consider therapy modification
Amphetamines: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Antipsychotic Agents (Second Generation [Atypical]): Blood Pressure Lowering Agents may enhance the hypotensive effect of Antipsychotic Agents (Second Generation [Atypical]). Risk C: Monitor therapy
Arginine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Barbiturates: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Benperidol: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Brigatinib may enhance the bradycardic effect of Antihypertensive Agents. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Bromperidol: May diminish the hypotensive effect of Blood Pressure Lowering Agents. Blood Pressure Lowering Agents may enhance the hypotensive effect of Bromperidol. Risk X: Avoid combination
Dexmethylphenidate: May diminish the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy
Diazoxide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
DULoxetine: Blood Pressure Lowering Agents may enhance the hypotensive effect of DULoxetine. Risk C: Monitor therapy
Flunarizine: May enhance the therapeutic effect of Antihypertensive Agents. Risk C: Monitor therapy
Herbal Products with Blood Pressure Increasing Effects: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Herbal Products with Blood Pressure Lowering Effects: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Hypotension-Associated Agents: Blood Pressure Lowering Agents may enhance the hypotensive effect of Hypotension-Associated Agents. Risk C: Monitor therapy
Indoramin: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Levodopa-Foslevodopa: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Foslevodopa. Risk C: Monitor therapy
Loop Diuretics: May enhance the hypotensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Lormetazepam: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Methylphenidate: May diminish the antihypertensive effect of Antihypertensive Agents. Risk C: Monitor therapy
Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicergoline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Risk C: 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. Risk D: Consider therapy modification
Pentoxifylline: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Pholcodine: Blood Pressure Lowering Agents may enhance the hypotensive effect of Pholcodine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Prazosin: Antihypertensive Agents may enhance the hypotensive effect of Prazosin. Risk C: Monitor therapy
Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Quinagolide: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Silodosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Risk C: Monitor therapy
Terazosin: Antihypertensive Agents may enhance the hypotensive effect of Terazosin. Risk C: Monitor therapy
Urapidil: Antihypertensive Agents may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy
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.
It is not known if fenoldopam is present in breast milk.
Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer.
Blood pressure, heart rate, ECG; serum potassium concentrations
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
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: IV: 1 hour
Distribution: Vd: 0.6 L/kg
Half-life elimination: IV: Children: 3 to 5 minutes; Adults: ~5 minutes
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
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