ARAMINE
Clinical safety rating
cautionComprehensive clinical and safety monograph for ARAMINE (ARAMINE).
Direct-acting sympathomimetic amine that stimulates alpha-adrenergic receptors, causing vasoconstriction and increased blood pressure.
| Metabolism | Primarily hepatic via oxidative deamination by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) |
| Excretion | Primarily renal: 85% unchanged drug in urine within 24 hours. Biliary/fecal: <5%. |
| Half-life | Terminal elimination half-life is 2-4 hours. Clinical context: Requires continuous infusion for sustained blood pressure support. |
| Protein binding | Approximately 50-70% bound to albumin and alpha-1 acid glycoprotein. |
| Volume of Distribution | 0.5-1.0 L/kg. Clinical meaning: Indicates extensive distribution into tissues, consistent with a polar catecholamine. |
| Bioavailability | Intramuscular: 100%; Subcutaneous: 100%; Oral: negligible (<5%) due to extensive first-pass metabolism. |
| Onset of Action | Intravenous: 1-2 minutes. Intramuscular: 10-15 minutes. Subcutaneous: 15-30 minutes. |
| Duration of Action | Intravenous: 10-15 minutes. Intramuscular: 30-60 minutes. Subcutaneous: 30-60 minutes. Clinical note: Short duration necessitates repeated doses or infusion. |
| Molecular Weight | 219.3 |
Intravenous infusion: 1-10 mg initially, then 0.5-5 mg/hr titrated to blood pressure. Intramuscular or subcutaneous: 2-10 mg every 2 hours as needed.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment guidelines; use with caution in severe renal impairment (GFR <30 mL/min) due to reduced clearance. |
| Liver impairment | No specific Child-Pugh based adjustments; use with caution in severe hepatic impairment due to altered metabolism. |
| Pediatric use | Intravenous infusion: 0.1-0.2 mg/kg/dose, titrate to effect; maximum 0.5 mg/kg/dose. |
| Geriatric use | Use lower initial doses (e.g., 0.5-1 mg IV) and titrate slowly due to increased sensitivity and risk of hypertension. |
| 1st trimester | Crosses placenta; possible risk of fetal vascular constriction and hypoxia. Use only if clearly needed. |
| 2nd trimester | Crosses placenta; use only if potential benefit outweighs fetal risk. |
| 3rd trimester | Crosses placenta; may cause uterine hyperstimulation and fetal bradycardia. Avoid near term. |
Clinical note
Comprehensive clinical and safety monograph for ARAMINE (ARAMINE).
| Placental transfer | Crosses placenta; documented in animal studies and human case reports. |
| Breastfeeding | Not detected in breast milk; likely compatible, but caution due to potential cardiovascular effects in infant. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | FDA Pregnancy Category C. First trimester: Animal studies show fetal abnormalities; no adequate human studies. Second/third trimester: Risk of maternal hypertension, reduced uterine blood flow; may cause fetal bradycardia, hypoxia, or metabolic acidosis. Avoid in eclampsia. |
| Fetal Monitoring | Continuous fetal heart rate monitoring; maternal blood pressure, heart rate, ECG, serum electrolytes, acid-base status. |
| Fertility Effects | No specific human data. Animal studies show no impairment of fertility at clinical doses. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to metaraminolHypersensitivity to sulfitesUse with MAOIs or within 14 days
| Precautions | Risk of extravasation leading to tissue necrosis, Use with caution in patients with hypertension, hyperthyroidism, or cardiovascular disease, May cause bradycardia reflexively, Monitor blood pressure closely during administration |
| Food/Dietary | Avoid tyramine-rich foods (e.g., aged cheeses, cured meats, fermented products) if taking MAOIs, but no specific dietary restrictions for metaraminol itself. Maintain adequate hydration as directed. |
| Clinical Pearls | ARAMINE (metaraminol) is a potent vasopressor used primarily for acute hypotension. Monitor blood pressure frequently, ideally via intra-arterial line, as its duration of action is prolonged (up to 1 hour) and may cause rebound hypertension. Avoid extravasation; central line administration preferred. Tachyphylaxis can occur with prolonged use. It is contraindicated in patients with MAOI use within 14 days due to hypertensive crisis risk. |
| Patient Advice | This medication is given intravenously to raise blood pressure during emergencies. · You will be closely monitored with frequent blood pressure checks and possible arterial line. · Report any chest pain, severe headache, or blurred vision immediately. · Inform your healthcare provider of all medications you take, especially antidepressants. · Do not stop or change the dose without medical advice. |
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