Nurses Compass
Drug Guide
Fenoldopam Mesylate
Classification
Therapeutic: Antihypertensive
Pharmacological: Dopamine D1 receptor agonist
FDA Approved Indications
- Hypertensive emergencies
Mechanism of Action
Fenoldopam selectively activates dopamine D1 receptors in renal, mesenteric, coronary, and peripheral vasculature, leading to vasodilation and a reduction in blood pressure. It also increases renal perfusion without significantly affecting heart rate or cardiac output.
Dosage and Administration
Adult: Initial dose: 0.1 micrograms/kg/min IV infusion, titrated up to 0.3 micrograms/kg/min as needed to control blood pressure.
Pediatric: Use not established; limited data available.
Geriatric: Start at lower doses due to potential increased sensitivity.
Renal Impairment: Adjustments generally not required; monitor blood pressure closely.
Hepatic Impairment: Data limited; use with caution.
Pharmacokinetics
Absorption: Administered IV; rapid onset.
Distribution: Widely distributed, crosses placental barrier.
Metabolism: Primarily hepatic metabolism.
Excretion: Excreted in urine as metabolites.
Half Life: Approximate half-life is 10 minutes.
Contraindications
- Known hypersensitivity to fenoldopam or other components.
- Concurrent use of linezolid (due to MAO inhibitory effects).
Precautions
- Use with caution in patients with increased intracranial pressure, angle-closure glaucoma, or during pregnancy/lactation.
Adverse Reactions - Common
- Reflex tachycardia (Common)
- Headache (Common)
- Nausea (Common)
- Hypotension (Common)
Adverse Reactions - Serious
- Allergic reactions including rash, pruritus, bronchospasm (Rare)
- Increased intraocular pressure (Rare)
Drug-Drug Interactions
- MAO inhibitors (e.g., linezolid), which can enhance hypotensive effects.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood pressure continuously during infusion. Assess renal function periodically.
Diagnoses:
- Risk for decreased cardiac output related to hypotension.
- Knowledge deficit regarding medication purpose and effects.
Implementation: Administer via infusion pump, titrate carefully to desired blood pressure. Ensure continuous blood pressure monitoring.
Evaluation: Assess effectiveness by sustained reduction in blood pressure without significant adverse effects.
Patient/Family Teaching
- Do not stop medication abruptly.
- Report any symptoms of headache, dizziness, or excessive hypotension.
- Attend follow-up appointments for blood pressure monitoring.
Special Considerations
Black Box Warnings:
- None at this time.
Genetic Factors: Limited data.
Lab Test Interference: May affect laboratory measurements indirectly by changing physiological parameters.
Overdose Management
Signs/Symptoms: Excessive hypotension, reflex tachycardia.
Treatment: Discontinue infusion immediately. Supportive measures include elevating the legs, administering IV fluids, and using vasoconstrictors if necessary.
Storage and Handling
Storage: Store at controlled room temperature, 20-25°C (68-77°F).
Stability: Stable under proper storage conditions; use within specified time after preparation.