CORLOPAM
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CORLOPAM (CORLOPAM).
Dopamine D1 receptor agonist; increases renal blood flow and sodium excretion; also D2 and alpha1 agonist at higher doses.
| Metabolism | Primarily hepatic via COMT and MAO; also metabolized by sulfation and glucuronidation. |
| Excretion | Renal: 70% as unchanged drug; biliary/fecal: 30% as metabolites |
| Half-life | Terminal elimination half-life: 2.5 hours; clinically, steady-state achieved within 4-5 half-lives (~12.5 hours) |
| Protein binding | 50% bound to albumin and alpha-1 acid glycoprotein |
| Volume of Distribution | 0.3-0.4 L/kg; indicates distribution primarily into extracellular fluid |
| Bioavailability | Intravenous only (100%); no oral formulation due to extensive first-pass metabolism |
| Onset of Action | Intravenous: 2-5 minutes after bolus; continuous infusion: 5-10 minutes |
| Duration of Action | 30-60 minutes after discontinuation; dose-dependent with renal function |
0.1-0.3 mcg/kg/min continuous IV infusion, titrated to effect; maximum 1.2 mcg/kg/min.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required for renal impairment; drug is primarily hepatically metabolized. |
| Liver impairment | Child-Pugh Class A: no adjustment; Child-Pugh Class B or C: consider dose reduction to 50% of normal initial dose and titrate cautiously. |
| Pediatric use | Not established; safety and efficacy in pediatric patients have not been studied. |
| Geriatric use | No specific dose adjustment; elderly patients may have increased sensitivity; start at low end of dosing range and titrate slowly. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CORLOPAM (CORLOPAM).
| Breastfeeding | It is unknown if fenoldopam is excreted in human breast milk. The M/P ratio is not available. Due to the potential for serious adverse effects in nursing infants, a decision should be made whether to discontinue nursing or discontinue the drug, considering the importance of the drug to the mother. |
| Teratogenic Risk | Fenoldopam (Corlopam) is a selective dopamine-1 receptor agonist. Animal studies have not shown teratogenic effects in rats or rabbits at doses up to 10-20 times the human dose. However, no adequate and well-controlled studies exist in pregnant women. During the first trimester, use only if clearly needed. In second and third trimesters, potential fetal effects include hypotension and reduced uterine blood flow due to maternal vasodilation. Risk cannot be excluded. |
■ FDA Black Box Warning
Not approved by FDA; no black box warning available.
| Serious Effects |
Hypersensitivity to fenoldopam; sulfite allergy (contains sodium metabisulfite); concurrent use with MAO inhibitors.
| Precautions | Hypotension, arrhythmias, myocardial ischemia; avoid in patients with ventricular fibrillation or atrial fibrillation with rapid ventricular response; monitor blood pressure, ECG, and renal function. |
| Food/Dietary | No known food interactions. However, intravenous fenoldopam may cause hypokalemia, so maintaining adequate potassium intake is important. Avoid excessive potassium supplementation unless monitored. |
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| Fetal Monitoring | Continuous monitoring of maternal blood pressure and heart rate is required due to risk of hypotension and reflex tachycardia. Fetal heart rate monitoring should be considered during prolonged use, especially in late pregnancy, due to potential for reduced uteroplacental perfusion. Serum electrolytes and renal function should be monitored regularly. |
| Fertility Effects | Fenoldopam has not been studied for effects on human fertility. In animal studies, no adverse effects on fertility were observed in rats at doses up to 10 mg/kg/day. There are no data on effects on spermatogenesis or oogenesis. |
| Clinical Pearls |
| CORLOPAM (fenoldopam) is a selective dopamine D1 receptor agonist used for in-hospital, short-term management of severe hypertension. It is not available orally and must be given intravenously. Onset is rapid (within minutes) and offset is short (half-life ~5 minutes), allowing precise titration. Monitor for hypotension, reflex tachycardia, and increased intraocular pressure. Contraindicated in patients with glaucoma. Use with caution in patients with hepatic impairment due to potential accumulation. Can cause hypokalemia; monitor serum potassium. Dose adjustment may be needed in elderly patients. Do not administer as a bolus; use continuous IV infusion only. Incompatible with heparin and sodium bicarbonate. |
| Patient Advice | This medication is given intravenously to rapidly lower very high blood pressure. · You will have continuous monitoring of your blood pressure and heart rate during treatment. · Report any symptoms such as dizziness, fainting, rapid heartbeat, or vision changes immediately. · Avoid foods high in potassium unless directed by your doctor, as this medication can affect potassium levels. · Do not stop the infusion abruptly; gradual weaning is required. · Inform your healthcare provider if you have glaucoma or a history of liver disease. · This medication is for short-term use in the hospital; you will need a long-term oral medication for ongoing blood pressure control. |