No

Vasodilator

Treatment of persistent pulmonary vasoconstriction and hypertension of the newborn (persistent fetal circulation), peripheral vasospastic disorders

C

Hypersensitivity to tolazoline; known or suspected coronary artery disease

Stimulates gastric secretion and may activate stress ulcers; therefore, use with caution in patients with gastritis, peptic ulcer; use with caution in patients with mitral stenosis

1% to 10%:

Endocrine & metabolic: Hypochloremic alkalosis

Gastrointestinal: GI bleeding, abdominal pain, nausea, diarrhea

Hematologic: Thrombocytopenia, increased agranulocytosis, pancytopenia

Local: Burning at injection site

Neuromuscular & skeletal: Increased pilomotor activity

Ocular: Mydriasis

Renal: Acute renal failure, oliguria

Respiratory: Pulmonary hemorrhage

Miscellaneous: Increased secretions

Symptoms of overdose include hypotension, shock, flushing

I.V. fluids and Trendelenburg position for hypotension; if pressors are required, use direct-acting alpha agonists (norepinephrine)

Decreased effect (vasopressor) of epinephrine followed by a rebound increase in blood pressure

Increased toxicity: Disulfiram reaction may possibly be seen with concomitant ethanol use

Compatible in D₅W, D₁₀W, and saline solutions

Competitively blocks alpha-adrenergic receptors to produce brief antagonism of circulating epinephrine and norepinephrine; reduces hypertension caused by catecholamines and causes vascular smooth muscle relaxation (direct action); results in peripheral vasodilation and decreased peripheral resistance

Half-life: Neonates: 3-10 hours, increased half-life with decreased renal function, oliguria

Time to peak serum concentration: Within 30 minutes

Elimination: Excreted rapidly in urine primarily as unchanged drug

Neonates: Initial: I.V.: 1-2 mg/kg over 10-15 minutes via scalp vein or upper extremity; maintenance: 1-2 mg/kg/hour; use lower maintenance doses in patients with decreased renal function. Also used in neonates for acute vasospasm "cath toes" at 0.25 mg/kg/hour (no load); maximum dose: 6-8 mg/kg/hour.

Dosing interval in renal impairment in newborns: Urine output <0.9 mL/kg/hour: Decrease dose to 0.08 mg/kg/hour for every 1 mg/kg of loading dose

Adults: Peripheral vasospastic disorder: I.M., I.V., S.C.: 10-50 mg 4 times/day

Alcohol: Avoid use

I.V.: Usual maximum concentration: 0.1 mg/mL

Vital signs, blood gases, cardiac monitor

None noted

May cause agranulocytosis, caution with clozapine and carbamazepine; use with alcohol may produce "disulfiram reaction"

No information available to require special precautions

No effects or complications reported

Side effects decrease with continued therapy; avoid alcohol

Dilute in D₅W; monitor blood pressure for hypotension; observe limbs for change in color; do not mix with any other drug in syringe or bag

Injection, as hydrochloride: 25 mg/mL (4 mL)

Ward RM, Daniel CH, Kendig JW, et al, "Oliguria and Tolazoline Pharmacokinetics in the Newborn," Pediatrics, 1986, 77(3):307-15.