Dosing and uses of Intropin (dopamine)
Adult dosage forms and strengths
infusion solution, in D5W
- 80mg/100mL
- 160mg/100mL
- 320mg/100mL
injectable solution
- 40mg/mL
- 80mg/mL
- 160mg/mL
Hemodynamic Conditions
Treatment of hypotension, low cardiac output, poor perfusion of vital organs; used to increase mean arterial pressure in septic shock patients who remain hypotensive after adequate volume expansion
1-5 mcg/kg/min IV (low dose): May increase urine output and renal blood flow
5-15 mcg/kg/min IV (medium dose): May increase renal blood flow, cardiac output, heart rate, and cardiac contractitlity
20-50 mcg/kg/min IV (high dose): May increase blood pressure and stimulate vasoconstriction; may not have a beneficial effect in blood pressure; may increase risk of tachyarrhythmias
May increase infusion by 1-4 mcg/kg/min at 10-30 min intervals until optimum response obtained
Titrate to desired response
Dosing Considerations
Strong beta1-adrenergic, alpha-adrenergic, and dopaminergic effects are based on dosing rate
Beta1 effects: 2-10 mcg/kg/min
Alpha effects: >10 mcg/kg/min
Dopaminergic effects: 0.5-2 mcg/kg/min
Pediatric dosage forms and strengths
infusion solution, in D5W
- 80mg/100mL
- 160mg/100mL
- 320mg/100mL
injectable solution
- 40mg/mL
- 80mg/mL
- 160mg/mL
Hemodynamic Conditions
Treatment of hypotension
1-5 mcg/kg/min IV, increased to 5-20 mcg/kg/min; not to exceed 50 mcg/kg/min
Titrate to desired response
Intropin (dopamine) adverse (side) effects
Frequency not defined
Cardiovascular: Ventricular arrhythmia, atrial fibrillation (at very high doses), ectopic beats, tachycardia, anginal pain, palpitation, cardiac conduction abnormalities, widened QRS complex, bradycardia, hypotension, hypertension, vasoconstriction
Respiratory: Dyspnea
Gastrointestinal: Nausea, vomiting
Metabolic/nutritional: Azotemia
Central nervous system: Headache, anxiety
Endocrine: Piloerection
Ocular: Increased intraocular pressure; dilated pupils
Gangrene of extremities has occurred when high doses were administered for prolonged periods or in patients with occlusive vascular disease receiving low doses of dopamine hydrochloride
Warnings
Black box warnings
May cause peripheral ischemia in patients with history of occlusive vascular disease
If ischemia occurs, prevent sloughing and necrosis in ischemic areas by infiltrating areas as soon as possible with 5-10 mg of phentolamine (adrenergic blocking agent) in 10-15 mL of saline solution
Contraindications
Hypersensitivity to dopamine, pheochromocytoma, ventricular fibrillation, uncorrected tachyarrhythmias
Cautions
Use caution in angina pectoris, extravasation, hypovolemia, occlusive vascular disease, ventricular arrhythmias, recent use of monoamine oxidase inhibitors, sensitivity to sulfites
Drug is inactivated by alkali
May cause increases in heart rate
Use with caution after myocardial infarction
Monitor blood pressure closely
Use caution in patients taking MAO inhibitors; prolong hypertension may occur with concurrent use
Pregnancy and lactation
Pregnancy category: C
Lactation: Unknown whether drug is excreted into breast milk; use caution
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 Intropin (dopamine)
Mechanism of action
Endogenous catecholamine, acting on both dopaminergic and adrenergic neurons
Low dose stimulates mainly dopaminergic receptors, producing renal and mesenteric vasodilation; higher dose stimulates both beta1-adrenergic and dopaminergic receptors, producing cardiac stimulation and renal vasodilation; large dose stimulates alpha-adrenergic receptors
Absorption
Onset: 5 min (adults)
Duration: <10 min
Distribution
Vd: 1.8-2.45 L/kg
Metabolism
Metabolized in liver, kidney, and plasma by monoamine oxidase and catechol-O-methyl transferase
Metabolites: Norepinephrine (active), inactive metabolites
Elimination
Half-life: 2 min
Total body clearance: 115 mL/kg/min
Excretion: Urine (80%)
Administration
IV Incompatibilities
Solution: Sodium bicarbonate 5%
Additive: Acyclovir, alteplase, amphotericin B, ampicillin, gentamicin(?), metronidazole/sodium bicarbonate, penicillin G potassium
Y-site: Acyclovir, aldesleukin(?), alteplase, amphotericin B cholesteryl sulfate, cefepime, furosemide(?; depends on formulation), heparin (in D5W), indomethacin, insulin, thiopental, TNA #222-223
IV Compatibilities
Solution: Most common solvents (eg, D5W, D10W, dextrose/saline, LR, NS, sodium lactate 1/6M)
Additive (partial list): Aminophylline, calcium gluconate, ciprofloxacin, dobutamine, heparin, hydrocortisone, lidocaine, nitroglycerin, potassium chloride, verapamiL
Syringe: Caffeine, doxapram, heparin, ranitidine
Y-site (partial list): Amiodarone, cisatracurium, diltiazem, dobutamine, epinephrine, esmolol, fentanyl, heparin (in NS), hydrocortisone sodium succinate, labetalol, lidocaine, lorazepam, morphine sulfate, nitroglycerin, ondansetron, potassium chloride, propofol, tacrolimus, verapamil, vitamins B and C, warfarin, zidovudine
Not specified: Carbenicillin, tetracycline, iron salts, oxidizing agents, alkaline solutions
IV Preparation
Dilute 200-400 mg in 250-500 mL of compatible diluent (eg, D5W, NS, LR, D5/NS, D5/LR); typical concentration range is 0.8-1.6 mg/mL, though up to 3.2 mg/mL has been used
Drug is stable for 24 hours after dilution
Premixed solution may be administered without dilution
Do not use if solution is darker than slightly yellow; discoloration to brown, pink, or purple indicates decomposition
IV Administration
Infuse via central line; umbilical arterial catheter is not recommended
Administer in large vein (eg, antecubital)
Use infusion pump to control flow rate
Titrate dosage to desired hemodynamic values or optimal urine flow
