Implementation

• High Alert: IV vasoactive medications are inherently dangerous. Before administering intravenously, have second practitioner independently check the original order, dose calculations, and infusion pump settings. Also, patient harm or fatalities have occurred when switching from oral to IV propranolol; oral and parenteral doses are not interchangeable. IV dose is 1/10 of the oral dose. Change to oral therapy as soon as possible. Do not confuse propranolol with pravachol. Do not confuse Inderal (a brand name of propranolol) with Adderall (an amphetamine/dextroamphetamine combination drug)

• PO: Take apical pulse prior to administering. If <50 bpm or if arrhythmia occurs, withhold medication and notify physician or other health care professional

» Administer with meals or directly after eating to enhance absorption

» Extended-release capsules should be swallowed whole; do not crush, open, or chewPropranolol tablets may be crushed and mixed with food

» Mix propranolol oral solution with liquid or semisolid food (water, juices, applesauce, puddings). To ensure entire dose is taken, rinse glass with more liquid or have patient consume all of the applesauce or pudding. Do not store after mixing

• Direct IV:
Diluent: Administer undiluted or dilute each 1 mg in 10 ml of D5W for injection.
Concentration: Undiluted: 1mg/ml. Diluted in 10 ml of D5W: 0.1 mg/ml

• Rate:
Administer at 0.5 mg/ min for adults to avoid hypotension and cardiac arrest; do not exceed 1 mg/min. Pedi: Administer over 10 min

• Intermittent Infusion:
Diluent: May be diluted in 50 ml of 0.9% NaCl, D5W, D5/0.45% NaCl, D5/0.9% NaCl, or lactated Ringer's injection.
Concentration: Depends on dose

• Rate:
Infuse over 10–15 min

• Syringe Compatibility:

» inamrinone

» milrinone

• Syringe Incompatibility:
pantoprazole

• Y-Site Compatibility:

» alteplase

» fenoldopam

» heparin

» hydrocortisone sodium succinate

» inamrinone

» linezolid

» meperidine

» milrinone

» morphine

» potassium chloride

» propofol

» tacrolimus

» vitamin B complex with C

• Y-Site Incompatibility:

» amphotericin B cholesteryl sulfate complex

» diazoxide

» lansoprazole

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