Parenteral Manual

Phentolamine mesylate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ROGITINE®, REGITINE®
Classification: 
Alpha-adrenergic blocking agent
Original Date: 
August 2005
Revised Date: 
January 2017
Indications: 
  • Diagnostic agent for pheochromocytoma
  • Hypertensive episodes in patients with pheochromocytoma
  • Treatment of alpha-adrenergic drug extravasation (eg. dobutamine, dopamine, phenylephrine) (may be used up to 12 hours after extravasation occurred)
Reconstitution and Stability: 
  • Available as 5 mg/mL ampoule
  • Refrigerate . Do not freeze
  • Protect from light & heat
  • Reconstituted solution stable 48 hours at room temperature and 1 week refrigerated
Compatibility: 

- Solution Compatible: 0.9% NaCl, D5W

- Additive/Above Cassette Compatible: no information

- Y-site Compatible: chlorpromazine, digoxin, diphenhydrinate, dobutamine, dopamine, fentanyl, midazolam, metronidazole, morphine, nitroglycerin, norepinephrine, KCl, ranitidine, vancomycin

- Incompatible: alkaline solutions (ampicillin, pentobarbital, phenobarbital), amphotericin B, cefazolin, cefotaxime, cefuroxime, clindamycin, cotrimoxazole, dexamethasone, furosemide, ganciclovir, hydralazine, insulin, ketorolac, penicillin

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC YES, for treatment of extravasation
Usual dilution: 0.5 mg/mL
IM YES, BP monitoring
IV Direct

YES, BP monitoring; norepinephrine must be available

Usual dilution: 0.5-1 mg/mL in NS or 5 mg/mL in SWI
Infusion time: over 1 minute
IV Intermittent Infusion NO
IV Continuous Infusion YES, BP monitoring
Usual dilution: dilute in D5W or 0.9% NaCl
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:
- Diagnosis of pheochromocytoma:

  • 0.05-0.1 mg/kg/dose IV/IM
  • Maximum single dose:  5 mg

- Hypertension (prior to surgery for pheochromocytoma): 

  • 0.05-0.1 mg/kg/dose IV/IM given 1-2 hours before pheochromocytomectomy, repeat PRN to control BP
  • Maximum single dose:  5 mg

- Extravasation of alpha-adrenergic drugs:

  • Infiltrate area with small amount of solution SC (made by diluting 5-10 mg in 10 mL NS) within 12 hours of extravasation;  DO NOT exceed 0.1-0.2 mg/kg SC or 5 mg total

Adult:
- Diagnosis of pheochromocytoma:

  • 5 mg IV/IM

- Hypertension (prior to surgery for pheochromocytoma): 

  • 5 mg IV/IM given 1-2 hours before pheochromocytomectomy, repeat PRN to control BP

- Extravasation of alpha-adrenergic drugs:

  • Infiltrate area with small amount of solution SC (made by diluting 5-10 mg in 10 mL NS) within 12 hours of extravasation;  DO NOT exceed 0.1-0.2 mg/kg SC or 5 mg total
Potential hazards of parenteral administration: 
  • Tachycardia, cardiac arrhythmias, angina
  • Hypotension
  • Transient dizziness, weakness, flushing
  • Nausea, vomiting, diarrhea
Notes: 
  • Monitor blood pressure and heart rate continuously         
  • To reverse hypotension use norepinephrine (Levarterenol - Levophed) infusion (DO NOT use epinephrine)
  • For extravasation:  infiltrate area of extravasation with multiple small injections - use 27 or 30 gauge needles and change needle between each skin entry (vasoconstriction should be reversed and area should pink up - observe closely - repeat doses may be needed)
  • Monitor the site of extravasation closely, as repeat doses of SC phentolamine may be needed

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