Key points
- We recommend to consult your poison centre with the use of this antidote.
- Except for treatment of vasoconstriction secondary to an extravasation of vasoconstrictor agents, phentolamine is rarely a first-line treatment and should only be considered following an inadequate response to initial treatments (e.g. benzodiazepines, nitroglycerin).
+ Synonyms and other terms
- Phentolamine mesylate
- Rogitine®
+ Indications
- Treatment of vasoconstriction secondary to extravasation of vasoconstrictor agents.
- Call your poison centre if for other indication.
+ Dosage
+ Pediatric Dose
- Treatment of extravasation
- 0.1 to 0.2 mg/kg (max. 10 mg) diluted in 10 ml of NS;
- Infiltrate the affected area with this solution using a 25 or 27 gauge hypodermic needle.
+ Adult Dose
- Treatment of extravasation
- 5 to 10 mg diluted in 10 ml of NS;
- Infiltrate the affected area with this solution using a 25 or 27 gauge hypodermic needle.
+ Renal Impairment
No data suggests that the dose should be modified for short-term use.
+ Hepatic Impairment
No data suggests that the dose should be modified for short-term use.
+ Hemodialysis Patient
No data suggests that the dose should be modified for short-term use.
+ Pregnancy
No data suggests that the dose should be modified for short-term use.
+ Obese or Overweight Patient
No data suggests that the dose should be modified for short-term use.
+ Adverse effects
- Hypotension and reflex tachycardia (with risk of angina in patients with coronary artery disease) if systemic administration.
- Flushing and headache if systemic administration.
+ Monitoring
- Blood pressure
- Heart rate
- Perfusion and skin temperature in cases of extravasation of vasoconstrictor agents
+ End of treatment
- Attainment and maintenance of acceptable vital signs according to clinical circumstances.
- Hyperaemia and/or return to normal temperature of area affected by extravasation of vasoconstrictors.
+ Special Notes on Administration
Intravenous Route (IV)
- Direct IV:
- Administer IV over 15 to 60 seconds.
- Small doses may be supplemented with NS to facilitate administration.
Intraosseous Route (IO)
- Possible alternative to IV route.
Subcutaneous Route (SC)
- Extravasation treatment
- Dilute the dose in 10 ml NS.
- Infiltrate affected area with this solution using a 25 or 27 gauge hypodermic needle.
Compatibility
Partial list only. Consult the pharmacist on duty at your health care facility.
- Compatible solutes: NS.
- Y-site compatibility: folic acid, alfentanil , aminophylline, amiodarone, atracurium, atropine, benztropine, bicarbonate (sodium), calcium (chloride and gluconate), chlorpromazine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, dopamine, dicalcium EDTA, enalaprilat, ephedrine, epinephrine , esmolol, famotidine, fentanyl, standard heparin, hydrocortisone, isoproterenol, labetalol, leucovorin calcium, lidocaine, lorazepam, magnesium (sulfate), mannitol, meperidine, metoclopramide, metoprolol, midazolam, morphine, MVI, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, pantoprazole, phenylephrine, phytonadione, potassium (acetate and chloride), procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, ranitidine, succinylcholine, sufentanil, theophylline, thiamine, vasopressin, verapamil.
- Y-site incompatibility: Dantrolene, diazepam, regular insulin, pentobarbital, phenobarbital, phenytoin.
Stability
- Vials/single-use ampoules. Discard any unused portion.
- Refrigerate at 2°C to 8° C and protect from light.
- No data on duration of stability when diluted in NS; use immediately.
+ Available products
- Phentolamine mesylate, 5 mg/ml, 1 ml per vial, Sandoz, DIN 02243737,
+ Amount required to treat a person weighting 70kg during 24 hours
- At least 100 mg.
+ References
Richards, John R., Dariush Garber, Erik G. Laurin, Timothy E. Albertson, Robert W. Derlet, Ezra A. Amsterdam, Kent R. Olson, Edward A. Ramoska, and Richard A. Lange. 2016. “Treatment of Cocaine Cardiovascular Toxicity: A Systematic Review.” Clinical Toxicology 54 (5):345–64.
Last updated
:
2022-11-25
