CHF and arrhythmias:
Indications for BREVIBLOC:
Rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short term control of ventricular rate with a short-acting agent is desirable. Noncompensatory sinus tachycardia where, in the physician’s judgment, the rapid heart rate requires specific intervention. For the treatment of tachycardia and hypertension that occur during induction and tracheal intubation, during surgery, on emergence from anesthesia, and in the postoperative period, when in the physician’s judgment such specific intervention is considered indicated.
Supraventricular tachycardia: Initial loading dose: 0.5mg/kg infused over 1 minute followed by maintenance infusion of 0.05mg/kg/min for the next 4 minutes. After the 4 minutes of initial maintenance infusion, depending upon desired ventricular response, may continue maintenance infusion at 0.05mg/kg/min or increase step-wise (eg, 0.1mg/kg/min, 0.15mg/kg/min, to max 0.2mg/kg/min) with each step being maintained for 4 or more minutes. If more rapid slowing of ventricular response is imperative, the 0.5mg/kg loading dose infused over a 1 minute period may be repeated, followed by a maintenance infusion of 0.1mg/kg/min for 4 minutes. Then, depending upon ventricular rate, another (and final) loading dose of 0.5mg/kg/min infused over a 1 minute period may be given followed by a maintenance infusion of 0.15mg/kg/min. If needed, after 4 minutes of the 0.15mg/kg/min maintenance infusion, the maintenance infusion may be increased to a maximum of 0.2mg/kg/min. See literature for transitioning to alternative antiarrhythmic agent. Intraoperative and postoperative tachycardia and/or hypertension: Immediate control: 80mg bolus dose over 30 seconds followed by 150mcg/kg/min infusion, if necessary. May adjust infusion rate as required up to 300mcg/kg/min. Gradual control: Give loading dose infusion of 500mcg/kg/min for 1 minute followed by 4-minute maintenance infusion of 50mcg/kg/min. If an adequate therapeutic effect is not observed within 5 minutes, repeat the same loading dose and follow with a maintenance infusion increased to 100mcg/kg/min.
Sinus bradycardia. Heart block >1st degree. Cardiogenic shock. Overt heart failure.
Hemodynamically compromised. Hypothermia. Bronchospastic disease; discontinue immediately if bronchospasm occurs. Diabetes. Renal impairment. Pregnancy (Cat.C). Nursing mothers.
Increased risk of cardiac failure with concomitant drugs that decrease peripheral resistance, myocardial filling or contractility, or electrical impulse propogation in the myocardium. May be potentiated by catecholamine-depleting drugs (eg, reserpine). Caution with digoxin, morphine, succinylcholine, warfarin, verapamil. Concomitant dopamine, epinephrine, norepinephrine: not recommended.
Hypotension, dizziness, somnolence, confusion, headache, agitation, GI upset, infusion site reactions.
Inj (10mL ready-to-use vials)—25; Double Strength Inj (5mL ready-to-use vials)—10; Premixed inj (250mL ready-to-use IntraVia Bags)—1; Premixed Double Strength Inj (100mL ready-to-use IntraVia Bags)—1