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
10 mg of Phentolamine can be added to each liter of solution containing norepinephrine. The pressor effect of norepinephrine is not affected.
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Phentolamine mesylate adds a new dimension to the pain management armamentarium of dentists. Not only do we possess an array of local anesthetics capable of providing clinical pain control for essentially all dental procedures, including postsurgical pain management, with phentolamine mesylate we now possess the ability to more quickly remove the oftentimes bothersome specter of prolonged soft-tissue anesthesia.
The safety profile for phentolamine mesylate at 1% solution proved consistent with previous trials.
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.
Our present practice is
to add 5 mg. of phentolamine to each liter of
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.
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.
Conditions producing hypertensive crisis from catecholamine surges (phenylephrine overdose, cocaine, tyramine interactions, pheochromocytoma) can be treated with phentolamine. Other uses include extravasation of some vasopressors (e.g. norepineprhine).
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.
Indications for phentolamine:
1. Diagnosis of pheochromocytoma.
2. Prevention / treatment of hypertensive episodes prior to or during surgery for
3. Antagonist to catecholamines in hypertensive crises.
4. Extravasation of alpha-adrenergic drugs (e.g. norepinephrine, dopamine, dobutamine,
5. Erectile dysfunction.
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).
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.
Type: Alpha 1 Blocker; Antidote, Extravasation; Antihypertensive.