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Publiziert am 18.04.2018
Table 2: Drugs used to increase heart rate. | ||||
Drug | Effect | Dosage | Pharmacokinetics | Comments |
Atropine | Muscarinic acetylcholine receptor antagonist | 0.5 mg i.v. (repeat every 3–5 minutes to max. 3 mg) | t½ 3−4hours. ~50% renal excretion. | Indicated in case of nodal block. Doses <0.5 mg may paradoxically worsen bradycardia. CI: glaucoma, prostatism, illeus |
Isoprenaline/
isoproterenol | Alpha-1, alpha-2, beta-1 and beta-2 adrenoreceptor agonist | Start infusion at 4 μg/min then up-/down-titrate over minutes to 1−10 μg/min based upon response | t½ 1 min | May not be well tolerated over many hours because of side effects (trembling, headache, etc) |
Adrenaline/ epinephrine | Alpha and beta adrenoreceptor agonist | Infusion 2–10 μg/min (titrate with response) | t½ 3 min followed by slower elimination (t½ 10 min) | Useful if hypotension is an issue (owing to vasoconstricting effect) |
Dopamine | Dopamine and alpha and beta adrenoreceptor agonist | Infusion 4−10 μg/kg/min | t½ 2 min | No bolus injections |
Dobutamine | Beta-1 adrenoreceptor agonist | Infusion 3−10 μg/kg/min | t½ 2 min | Useful if concurrent inotropic insufficiency |
Theophylline | Adenosine receptor antagonist and phosphodiesterase inhibitor | 100−200 mg slow i.v. injection | t½ 4−24 h (affected by age, smoking, hepatic function, drug interactions, etc.) | Infrequently used for treating bradycardia |
Aminophylline | Adenosine receptor antagonist and phosphodiesterase inhibitor | 200−300 mg slow i.v. injection | Infrequently used for treating bradycardia | |
All drugs should be used with caution in cases with cardiac ischaemia. t½ = half-life; CI = contraindication |
Table 3: Specific treatment options for bradycardia due to drug toxicity. | ||
Drug causing bradycardia | Treatment | Comments |
Beta-blocker | Glucagon | First-line antidote 2–10 mg bolus followed by 2–5 mg/h infusion |
Inotropes: adrenaline, dobutamine, isoprenaline | Competitive beta-receptor agonists High doses often required to overcome the effect of beta-blockade | |
Calcium channel blocker | Intravenous calcium | First-line antidote Partially overcomes calcium blockade Calcium chloride or calcium gluconate can be given as boluses or infusion—monitor levels |
Glucagon | Can be used as bolus or infusion: 2–10 mg bolus followed by 2–5 mg/h infusion | |
Digoxin | Digoxin-specific antibodies (Fab fragments) | First-line antidote Allergenic and expensive. Only to be used in life-threatening arrhythmias attributed to digoxin. |
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