Dosing and uses of Dobutamine
Adult dosage forms and strengths
infusion solution, in D5W
- 100mg/100mL
- 200mg/100mL
- 400mg/100mL
injectable solution
- 12.5mg/mL
Cardiac Decompensation
0.5-1 mcg/kg/min IV continuous infusion initially, then 2-20 mcg/kg/min; not to exceed 40 mcg/kg/min
Low Cardiac Output (Off-label)
2-20 mcg/kg/min IV or IO; titrate to desired effect; not to exceed 40 mcg/kg/min
Pediatric dosage forms and strengths
infusion solution, in D5W
- 100mg/100mL
- 200mg/100mL
- 400mg/100mL
injectable solution
- 12.5mg/mL
Cardiac Decompensation
0.5-1 mcg/kg/min IV continuous infusion initially, then 2-20 mcg/kg/min; not to exceed 40 mcg/kg/min
Dobutamine adverse (side) effects
1-10%
Tachyarrhythmia (~10%)
Hypertension (7.5%)
Eosinophilic myocarditis (≤7%)
Premature ventricular beats (5%; dose related)
Angina (1-3%)
Dyspnea (1-3%)
Fever (1-3%)
Headache (1-3%)
Nausea (1-3%)
Palpation (1-3%)
Frequency not defined
Cardiac dysrhythmia
Exacerbation of coronary arteriosclerosis
Hypokalemia
Injection-site reactions
Syncope
10- to 20-mm Hg increase in systolic blood pressure and increase in heart rate of 5 to 15 beats/min
Warnings
Contraindications
Hypersensitivity to drug or components
Idiopathic hypertrophic subaortic stenosis
Cautions
To optimize hemodynamics, correct hypovolemia if needed
Clinical experience with dobutamine following myocardial infarction has been insufficient to establish safety of drug for this use; there is concern that any agent that increases contractile force and heart rate may increase size of infarction by intensifying ischemia, but not known whether dobutamine does so
Severe coronary artery disease (CAD)
Hypertension common; hypotension may also occur
May cause a marked increase in heart rate or blood pressure,especially systolic pressure; because dobutamine facilitates atrioventricular conduction, patients with atrial fibrillation are at risk of developing rapid ventricular response; in patients who have atrial fibrillation with rapid ventricular response, a digitalis preparation should be used prior to institution of therapy with dobutamine; patients with pre-existing hypertension appear to face an increased risk of developing an exaggerated pressure response
During administration of dobutamine, monitor blood pressure continuously; pulmonary wedge pressure and cardiac output should be monitored whenever possible to aid safe and effective infusion of dobutamine in 5% dextrose Injection, USp
Ventricular ectopy exacerbation may occur
Pregnancy and lactation
Pregnancy category: B
Lactation: Unknown whether drug is excreted into breast milk; avoid use
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Dobutamine
Mechanism of action
Strong beta1 and weak beta2/alpha effects, resulting in increased cardiac output, blood pressure, and heart rate, as well as decreased peripheral vascular resistance
Absorption
Onset: 1-10 min
Duration: 10 min
Time to peak effect: ~15 min
Distribution
Vd: 0.2 L/kg
Metabolism
Metabolized in tissues and liver by catechol-O-methyl transferase
Metabolites: Glucuronide conjugate, 3-0-methylated dobutamine (inactive)
Elimination
Half-life: 2 min
Clearance: 90 mL/kg/min
Excretion: Urine
Administration
IV Incompatibilities
Solution: Sodium bicarbonate 5%
Additive: Acyclovir, alteplase, aminophylline, bretylium(?), bumetanide, calcium chloride(?), calcium gluconate, diazepam, digoxin, floxacillin, furosemide, heparin(?), insulin, magnesium sulfate, phenytoin, potassium phosphates, sodium bicarbonate
Syringe: Doxapram
Y-site: Acyclovir, alatrofloxacin, alteplase, aminophylline, amphotericin B cholesteryl sulfate, cefepime, foscarnet, furosemide(?), heparin(?), indomethacin, phytonadione, piperacillin-tazobactam, thiopental, warfarin
IV Compatibilities
Solution: Most common solvents (D5/LR, D5/NS, D5W, LR, NS)
Additive (partial list): Amiodarone, atropine, ciprofloxacin, dopamine, epinephrine, flumazenil, hydralazine, lidocaine, meperidine, morphine sulfate, nitroglycerin, nitroglycerin with nitroprusside(?), norepinephrine, potassium chloride(?), verapamil (incompatible at higher concentrations)
Syringe: Caffeine citrate, heparin, ranitidine
Y-site (partial list): Amiodarone, atracurium, calcium gluconate, ciprofloxacin, diazepam, diltiazem, dopamine, epinephrine, fentanyl, inamrinone, labetalol, lidocaine, lorazepam, magnesium sulfate, midazolam(?), morphine sulfate, nitroglycerin, norepinephrine, potassium chloride, propofol, sodium nitroprusside, tacrolimus, vasopressin, verapamil, zidovudine
IV Preparation
Solution: Dilute 250 mg in 250 mL of compatible solution to yield final concentration of 1000 mcg/mL; not to exceed 5000 mcg/mL
IV Administration
Infuse into large vein via infusion pump
Storage
Store intact vials at room temperature; protect from excessive heat or freezing conditions
Diluted solutions may be stored for 24 hours
