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All about: Dobutamine

Big Image Pronouncation: (doe-BYOOT-uh-meen)
Class: Vasopressor

Trade Names:
Dobutamine Hydrochloride
- Injection 12.5 mg/mL

Mechanism of Action

Pharmacology

Stimulates beta 1 -receptors in heart, causing more complete and forceful contractions (inotropy) without significantly increasing heart rate or BP.

Pharmacokinetics

Metabolism

Methylation and conjugation.

Elimination

t ½ is 2 min. Urinary excretion of metabolites.

Onset

1 to 2 min.

Peak

Up to 10 min.

Indications and Usage

Treatment of cardiac decompensation caused by organic heart disease or cardiac surgical procedures.

Unlabeled Uses

Congenital heart disease in children undergoing diagnostic cardiac catheterization.

Contraindications

Idiopathic hypertrophic subaortic stenosis.

Dosage and Administration

Adults

IV infusion 2.5 to 10 mcg/kg/min; titrate to desired response; increase in heart rate more than 10% may develop in rate greater than 20 mcg/kg/min; rates up to 40 mcg/kg/min are rarely used. Duration of therapy up to 72 h without decrease in clinical effectiveness may be used.

General Advice

  • Administer by IV infusion only. Use electronic infusion device to monitor infusion rate.
  • Reconstitution/dilution is done in two stages.
  • First, more concentrated solution can be kept under refrigeration for 48 h or at room temperature for 6 h.
  • Before administration, solution is further diluted to typical concentration of 0.25 to 1 mg/mL (250 to 1,000 mcg/mL). Final concentration should not exceed 5 mg/mL. This solution should be used within 24 h.
  • Solution may have pink color, because of slight oxidation, but this effect does not indicate loss of potency.

Storage/Stability

Do not freeze solution because crystallization may occur.

Drug Interactions

Beta-blockers

May antagonize beta receptor-stimulating activity of dobutamine.

Furazolidone, methyldopa, rauwolfia alkaloids

Hypertension may result.

Guanethidine

May increase pressor response.

Halogenated hydrocarbon anesthetics

May increase risk of arrhythmias by sensitizing cardiac tissue to sympathomimetic agents.

Tricyclic antidepressants

May potentiate effect of dobutamine; use combination with caution.

Incompatibility

Chemically incompatible with sodium bicarbonate or other alkaline solutions.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Increased systolic BP; increased heart rate; chest pain; increased number of premature ventricular beats.

CNS

Headache; tingling sensations; paresthesia.

GI

Nausea; vomiting.

Respiratory

Dyspnea.

Miscellaneous

Phlebitis; local inflammation after infiltration; leg cramps.

Precautions

Monitor

Monitor vital signs, ECG, cardiac output, pulmonary capillary wedge pressure, central venous pressure and urinary output carefully throughout infusion. Monitor patency and placement of IV catheter to reduce risk of extravasation and phlebitis.


Pregnancy

Safety not established.

Lactation

Undetermined.

Children

Safety and efficacy not established.

Special Risk Patients

Use with extreme caution after myocardial ischemia. Avoid use in uncorrected hypovolemic states unless used as temporary emergency measure to maintain coronary and cerebral flow.

Sulfite Sensitivity

Use caution in sulfite-sensitive individuals; some preparations contain sodium bisulfite.

CV effects

May greatly increase BP and heart rate, especially with preexisting hypertension. Dose reduction may reverse effects. May precipitate or exacerbate ventricular ectopic activity.

Hypokalemia

Mild hypokalemia may occur.

Overdosage

Symptoms

Excessive hypertension, tachycardia, nausea, vomiting, tremor, headache, chest pain.

Patient Information

  • Instruct patient to report these symptoms to health care provider: pain or discomfort at IV site, any anginal pain.

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