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Phentolamine Use in Hypertensive Crisis

Conditions producing hypertensive crisis from catecholamine surges (phenylephrine overdose, cocaine, tyramine interactions, pheochromocytoma) can be treated with phentolamine

Phentolamine is a nonspecifc alpha blocking agent which produces peripheral vasodilation with a resultant fall in blood pressure in most patients.

Other uses include extravasation of some vasopressors (e.g. norepineprhine)

May see an increase in HR after administration (once alpha blockade is established, beta-blocker can be administered)

Dose: 5-15 mg IV/IM Duration: 30-45 minutes

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 Pheochromocytoma Crisis in the Emergency Department

In a hypertensive crisis with a pheochromocytoma, intravenous phentolamine provides the optimal blockade of catecholamine-induced vasoconstriction as a non-selective alpha-receptor blocker which may be given as an initial test dose of 1 mg followed by repeat 5 mg boluses or continuous infusion at 0.5-1 mg/minute

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Treatment Choices for Severe Hypertension

Phentolamine, a competitive peripheral alpha-1 and alpha-2 receptor antagonist, has been used to treat hypertension associated with catecholamine excess. It is most commonly used in the alpha-blockade phase of pheochromocytoma treatment and is the drug of choice for adrenergic crises only. It has been used to treat hypertension related to cocaine toxicity, amphetamine overdose, clonidine withdrawal, and monoamine oxidase inhibitor interactions with food and other drugs.

Treatment of Shock and Prevention of Ischemic Necrosis with Levarterenol-Phentolamine Mixtures

Our present practice is to add 5 mg. of phentolamine to each liter of levarterenol solution.

What Is Phentolamine Mesylate?

The medication known as phentolamine mesylate reverses anesthesia and hypertension. Health care providers might also administer phentolamine mesylate simultaneously with norepinephrine. The hormone notoriously causes tissue damage at the injection site and the alpha-blocker prevents this occurrence.

What to do with norepinephrine extravasation

Depending on the size of the extravasation, bring 5 to 10 mg of phentolamine to the bedside. This will need to be reconstituted, and further diluted to 0.5 mg/mL in normal saline.

Resources

Phentolamine Mesylate

Phentolamine Mesylate for Injection, USP is indicated for the prevention or control of hypertensive episodes that may occur in a patient with pheochromocytoma as a result of stress or manipulation during preoperative preparation and surgical excision.

Phentolamine Mesylate Injection

Indications for phentolamine: 1. Diagnosis of pheochromocytoma. 2. Prevention / treatment of hypertensive episodes prior to or during surgery for pheochromocytoma. 3. Antagonist to catecholamines in hypertensive crises. 4. Extravasation of alpha-adrenergic drugs (e.g. norepinephrine, dopamine, dobutamine, phenylephrine). 5. Erectile dysfunction.

CHEO

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).

ScienceDirect

Phentolamine is a competitive non selective antagonist of alpha-adrenergic receptors. In fact, it binds α1 and α2 receptors with similar affinities. Therefore its main effects (see glossary) are hypotension and tachycardia.

WikEM

Type: Alpha 1 Blocker; Antidote, Extravasation; Antihypertensive.