Fenoldopam (Corlopam) is a dopamine (D-1 receptor) agonist with minimal adrenergic effects. It is a rapidly acting vasodilator and is used in situations where a rapid decrease in the blood pressure is required such as hypertensive urgency and emergency.

Fenoldopam Uses:

• Severe hypertension:

  • It is for the short-term treatment of uncontrolled hypertension (up to 48 hours while the patient is in the hospital).
  • It is also used to treat patients with malignant hypertension, in patients with deteriorating end-organ dysfunction secondary to uncontrolled hypertension, and for the reduction of blood pressure in children.

Fenoldopam (Corlopam) Dose in Adults

Fenoldopam (Corlopam) Dose in the treatment of Severe hypertension:

• It is administered intravenously at a dose of 0.01 - 0.3 mcg/kg/minute initially.
• Until the goal blood pressure is reached, the dose may be raised in increments of 0.05 to 0.1 mcg/kg/minute every 15 minutes.
• Clinical trials have revealed a maximal infusion rate of 1.6 mcg/kg/minute.
• The drug is usually administered for a period of 48 hours while the patient is in the hospital.

Note: Patients may continue oral antihypertensive medications while on treatment or after the infusion.

Fenoldopam (Corlopam) Dose in Children

Fenoldopam (Corlopam) Dose in the treatment of Severe hypertension:

• Infants, Children, and Adolescents: IV:

  • Continuous IV infusion:
    • Starting with a continuous intravenous infusion of 0.2 mcg/kg/minute.
    • Every 20 to 30 minutes, the dose may be raised by 0.3 to 0.5 mcg/kg/minute.
    • 0.8 mcg/kg/minute is the maximum dose.
    • Higher doses may not have additional blood pressure lowering effects and may worsen tachycardia.

Pregnancy Risk Factor B

• Only use it during pregnancy if clearly indicated.
• However, it has not yet been investigated in human pregnancies. Animal reproduction studies have not shown any evidence of fetal harm.

Fenoldopam use during breastfeeding:

• The data on the presence of the drug is not available.
• The manufacturer suggests that breastfeeding be stopped because of the possibility of serious side effects in infants breastfeeding with the drug.
• This is in line with the mother's rights and the risks to the infant from drug exposure.

Dose in Kidney Disease:

• The manufacturer has not recommended any dosage adjustment in the dose.
• The effects of hemodialysis on the drug have not been evaluated.

Dose in Liver disease:

The manufacturer has not recommended any dosage adjustment in the dose.

Side Effects of Fenoldopam (Corlopam):

• Cardiovascular:

  • Flushing
  • Hypotension

• Central nervous system:

  • Headache

• Gastrointestinal:

  • Nausea

Less Common Side Effects of Fenoldopam (Corlopam):

• Cardiovascular:

  • Angina Pectoris
  • Bradycardia
  • Cardiac Failure
  • Chest Pain
  • ECG Abnormality (ST-T Abnormalities)
  • Extrasystoles
  • Inversion T Wave On ECG
  • Myocardial Infarction
  • Orthostatic Hypotension
  • Palpitations
  • Tachycardia

• Central Nervous System:

  • Anxiety
  • Dizziness
  • Insomnia

• Dermatologic:

  • Diaphoresis

• Endocrine & Metabolic:

  • Hyperglycemia
  • Hypokalemia
  • Increased Lactate Dehydrogenase

• Gastrointestinal:

  • Abdominal Distention
  • Abdominal Pain
  • Constipation
  • Diarrhea
  • Vomiting

• Genitourinary:

  • Oliguria
  • Urinary Tract Infection

• Hematologic & Oncologic:

  • Hemorrhage
  • Leukocytosis

• Hepatic:

  • Increased Serum Transaminases

• Local:

  • Injection Site Reaction

• Neuromuscular & Skeletal:

  • Back Pain
  • Muscle Cramps (Limbs)

• Ophthalmic:

  • Increased Intraocular Pressure

• Renal:

  • Increased Blood Urea Nitrogen
  • Increased Serum Creatinine

• Respiratory:

  • Dyspnea
  • Nasal Congestion

• Miscellaneous:

  • Fever

Contraindications to Fenoldopam (Corlopam):

The manufacturer's labeling does not contain any contraindications.

Warnings and precautions

• Hypokalemia

  • Hypokalemia may occur in patients who receive the infusion within six hours.
  • It is important to monitor potassium levels.

• Tachycardia

  • Tachycardia is possible, particularly if the rate of infusion exceeds 0.01 mcg/kg/minute for adults and 0.8 mg/kg/minute for children.
  • Reflex tachycardia is less likely when the infusion rate is lower than 0.1 mg/kg/minute, and the drug is titrated slower.

• Angina

  • Tachycardia may occur due to an increase in myocardial oxygen requirement.
  • Patients with obstructive or persistent coronary artery disease should not use it.

• Glaucoma:

  • Patients with intraocular hypertension and glaucoma may experience an increase in intraocular pressure that is dose-dependent.
  • The intraocular pressure will return to baseline in two hours if the rate of infusion decreases.

Fenoldopam: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Blood pressure,
• heart rate,
• ECG
• serum potassium concentrations

How to administer Fenoldopam (Corlopam)?

It's given as an ongoing intravenous infusion.

Fenoldopam Mechanism of action:

It is a particular type of dopaminergic post-synaptic agonist (D-1-receptors). It produces quick-acting hypotensive effects through:

• decreasing peripheral vascular resistance and increased renal blood flow,
• diuresis, and
• natriuresis;

It has little adrenergic activity and is six times more effective than dopamine at causing renal vascular dilatation.

The start of an intravenous drug's effects:

• Children: 5 minutes;
• Adults: 10 minutes;
• Note: Most of the effects of the drug can be seen within 15 minutes.

Duration of action: IV:

• 1 hour

Half-life elimination: IV:

• Children: 3 to 5 minutes;
• Adults:  about 5 minutes

Metabolism:

• It undergoes methylation, glucuronidation, and sulfation in the liver, and the 8-sulfate metabolite may have some action;
• It has a significant first-pass impact.

Excretion:

• Urine (90%);
• feces (10%)

International Brand Names of Fenoldopam:

• Corlopam

Fenoldopam Brand Names in Pakistan:

No Brands Available in Pakistan.