AdrenomedullinComplete Dosing & Administration Guide

Mild discomfort at treatment site

Some users experience mild discomfort, which is among the most commonly reported effects with Adrenomedullin. This typically resolves within a few days as the body adjusts.

Management: Apply ice if needed. Rotate treatment sites. These symptoms typically improve within the first week of use.

Excessive blood pressure lowering (hypotension)

Adrenomedullin is a potent vasodilator, and hypotension occurs in 30-50% of patients receiving therapeutic doses (0.5-1.5 mcg/kg/min). Systolic BP typically drops 15-40 mmHg, and diastolic 10-25 mmHg. This is the primary dose-limiting toxicity. Risk is highest in patients already on antihypertensive therapy or with baseline volume depletion.

Management: Continuous blood pressure monitoring is essential—this should occur during infusions and frequently during initial treatment. Baseline and daily orthostatic vital signs are critical. Maintain adequate intravascular volume with IV fluids—liberal saline infusions often accompany adrenomedullin. Position patient upright gradually when standing. Hold other vasodilators and reduce antihypertensive agents. If systolic BP drops below 90 mmHg or becomes symptomatic (syncope, severe dizziness), reduce infusion rate or hold dose temporarily. Vasopressors (norepinephrine, dopamine) are available if severe hypotension develops.

Headaches (from pressure changes)

Headaches occur in 15-25% of patients, typically resulting from rapid blood pressure reductions and cerebral vasodilation. Headaches are usually mild-to-moderate, frontal or generalized, and appear within 30 minutes to 2 hours of infusion start. Most resolve within 4 hours of infusion completion.

Management: Headaches often reflect appropriate vasodilation and are not dangerous themselves. Ensure adequate hydration—dehydration worsens headaches. Position patient supine or semi-supine to optimize cerebral perfusion. Acetaminophen (650-1000 mg) or NSAIDs (ibuprofen 400 mg) may help, but avoid if patient has renal compromise (common in sepsis). Ice packs to the forehead/neck can provide relief. Most headaches improve once the body acclimates, usually within 24-48 hours of continued infusion. Report severe headache, vision changes, or neurological symptoms immediately.

Flushing and mild facial redness

Flushing (sudden facial warmth and redness) occurs in 20-35% of patients, typically at the start of infusion or with dose increases. This reflects cutaneous vasodilation and is direct evidence of the medication's vasodilatory activity. Episodes usually last 5-15 minutes and are cosmetically bothersome but not medically dangerous.

Management: Flushing is a normal sign of treatment effect and doesn't require intervention—inform patients this is expected. Keep room temperature cool and ensure adequate ventilation. Wet washclothes or ice packs on the face can provide comfort. Avoid hot drinks and warm blankets during treatment. Flushing typically diminishes as patients develop tolerance, usually within the first 2-3 hours of infusion. This side effect indicates active drug effect and doesn't warrant dose reduction unless accompanied by hypotension.

Dizziness or lightheadedness

Dizziness occurs in 15-30% of patients, primarily secondary to blood pressure reduction and possibly dysautonomia during septic states. Orthostatic dizziness is more common than positional vertigo. Severity correlates with BP drops and baseline volume status.

Management: Maintain supine or semi-upright position during infusion—patients receiving IV adrenomedullin are typically ICU-level and bed-bound. Rise position changes gradually if patient ambulates. Ensure adequate hydration and monitor urine output. Dizziness often improves as the body compensates and BP stabilizes. If dizziness is accompanied by syncope, severe hypotension, or altered mental status, reduce infusion rate or discontinue temporarily and notify provider. ECG monitoring should accompany treatment in unstable patients.

Mild electrolyte shifts

Adrenomedullin has natriuretic and diuretic properties—it increases sodium and water excretion through renal mechanisms. Electrolyte abnormalities (hyponatremia, hypokalemia) occur in 10-20% of patients with prolonged infusion, particularly those receiving concurrent aggressive IV hydration. Potassium can drop 0.3-0.7 mEq/L, and sodium may fall 2-5 mEq/L in 24-48 hours.

Management: Baseline electrolyte panel (sodium, potassium, magnesium, calcium) is essential. Monitor electrolytes daily during treatment, more frequently if infusion >24 hours. Replace losses judiciously—avoid hyperosmolar replacement as this can worsen outcomes in sepsis. Potassium supplementation (potassium chloride 20-40 mEq) may be needed if K+ drops below 3.5 mEq/L. Hold diuretics during adrenomedullin therapy unless specifically indicated. Monitor for signs of hyponatremia (confusion, seizure) or hypokalemia (cardiac arrhythmias, weakness).

Localized injection site reactions

When adrenomedullin is given IV or by central line, phlebitis (vein inflammation) occurs in 5-15% of patients receiving peripheral IV infusions. Central lines rarely show this issue. Local pain, erythema, and edema typically develop within 24 hours. Adrenomedullin is not vesicant, but irritation occurs due to pH and osmolarity.

Management: Central venous access is preferred for adrenomedullin if infusion duration >24 hours. If peripheral IV necessary, select large bore (18 gauge or larger) and change sites every 48-72 hours. Flush line frequently with normal saline. Observe for phlebitis signs: pain, erythema, warmth, cord-like vein appearance. Apply warm compresses post-infusion to manage mild phlebitis. Discontinue peripheral access and establish central line if significant phlebitis develops. No pharmacological prevention is indicated—mechanical management (site care, line rotation) is standard.

Increased urination (natriuretic effect)

Adrenomedullin is a natriuretic agent, and increased urine output occurs in 60-80% of patients. Urine output can increase 1.5-3 fold above baseline, with diuresis often exceeding 200 mL/hour. Sodium and water excretion both increase, which can be therapeutic in volume overload but problematic in euvolemic or hypovolemic patients.

Management: Monitor strict intake/output hourly during treatment—continuous urinary catheterization is standard in ICU settings where adrenomedullin is used. Weigh patient daily if possible. Replace urine losses carefully—excessive replacement can negate therapeutic diuresis and worsen pulmonary edema in heart failure patients. In sepsis, mild diuresis can improve oxygenation. Maintain serum sodium >130 mEq/L and K+ >3.5 mEq/L. Monitor for acute kidney injury—adrenomedullin can worsen renal function if urine losses aren't replaced. Discontinue if UO drops sharply, signaling possible renal dysfunction.