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IV, Isoproternol

Isoproterenol is a nonselective β‑agonist that increases heart rate and AV‑nodal conduction without vasopressor effect (Circulation 2018 1).

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Indications d'utilisation

Used for symptomatic bradycardia when atropine is ineffective and coronary ischemia is unlikely, to increase sinus/AV nodal conduction and heart rate (ACC/AHA/HRS 2018 1 [Level I evidence]). Also useful as a chronotropic agent in electrophysiology labs and as bridge therapy before pacing (same guideline 2 [Level I evidence]). Avoid in suspected ischemia due to risk of worsening hypotension/ischemia.

Informations et précautions

Start with low‑dose infusion and titrate only to the minimal chronotropic effect needed; it improves nodal conduction but causes vasodilation and increased myocardial O₂ demand, so avoid when ischemia is suspected (ACC/AHA/HRS Bradycardia Guideline 1 [Level I evidence]).

Use mainly as EP‑lab agent or second‑line rescue for bradycardia.
Monitor for chest pain and arrhythmias; hypotension may worsen.
Prefer pacing when available.