Dopamine Hydrochloride

Pronunciation

Class: Selective beta-1-Adrenergic Agonists
VA Class: AU100
CAS Number: 62-31-7

Warning(s)

  • Extravasation Risk
  • Phentolamine is the local antidote for prevention of local ischemic changes resulting from extravasation of dopamine.a b c

  • Phentolamine should be given as soon as possible after the extravasation is noted.a b c

  • The affected area can be identified by coldness, hardness, and a pallid appearance.b

  • Infiltrate the affected area (using a syringe with a fine hypodermic needle) liberally throughout as soon as possible with 10–15 mL of 0.9% sodium chloride injection containing 5–10 mg of phentolamine mesylate (an α-adrenergic blocking agent) to prevent sloughing and necrosis in ischemic areas.a b c

  • In children, phentolamine mesylate doses of 0.1–0.2 mg/kg (maximum: 10 mg per dose) may be infiltrated.b

  • Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours.a b c

Introduction

Dopamine, an endogenous catecholamine that is the immediate precursor of norepinephrine, is a sympathomimetic agent with prominent dopaminergic and β1-adrenergic effects at low to moderate doses and α-adrenergic effects at high doses.b 112

Uses for Dopamine Hydrochloride

Shock

Used to increase cardiac output, BP, and urine flow as an adjunct in the treatment of shock that persists after adequate fluid volume replacement and when systemic vascular resistance is decreased.100 112 b Individual hemodynamic abnormalities must be identified and monitored so that therapy can be adjusted as necessary.b

It has not been established whether dopamine decreases mortality due to shock in spite of drug-induced increases in cardiac output, BP, and urine flow.b

Has been used to support cardiac output and maintain arterial pressure during intra-aortic balloon counterpulsation therapy (e.g., in patients with hypotensive cardiogenic shock following AMI).b

May be considered for the treatment of drug-induced hypovolemic shock, when patient is unresponsive to fluid volume expansion and inotropic and/or vasopressor support is required.112

Use in low cardiac output syndrome following open heart surgery can increase long-term survival.b However, because of pharmacologic and pharmacodynamic differences, dobutamine may be preferable in the period immediately following cardiopulmonary bypass surgery.b

May increase cardiac output, BP, and urine flow in shock that is refractory to other agents.b

Appears to be most effective when therapy is begun shortly after the signs and symptoms of shock appear and before physiologic parameters such as BP and myocardial function undergo severe deterioration and before urine flow has decreased to <0.3 mL/minute.b

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CPR

Used to increase cardiac output and BP in ACLS during CPR.100 112 b

Treatment of symptomatic bradycardia unresponsive to atropine, as a temporizing measure while awaiting availability of a pacemaker, or if pacing ineffective.112

Often used for the management of hypotension, particularly if associated with symptomatic bradycardia or after return of spontaneous circulation.100 112 b

Useful in the management of postresuscitation hypotension when combined with other agents such as dobutamine.100 112 b

If hypotension persists after filling pressure (i.e., intravascular volume) is optimized, drugs with combined inotropic and vasopressor actions (e.g., epinephrine, norepinephrine) may be used.100 112

Acute Renal Failure

Low-dose (“renal dose,” e.g., <5 mcg/kg per minute) therapy does not appear to prevent or ameliorate acute (e.g., oliguric) renal failure in critically ill patients100 102 105 106 107 108 b 112 despite some evidence of increased renal and mesenteric perfusion from selective dopaminergic effects.107 109 110 Although diuresis may occur, GFR does not improve, and such therapy no longer is recommended.100

In addition, low-dose dopamine infusions are not without risk and may be associated with adverse effects (e.g., suppression of respiratory drive,101 102 104 106 increased cardiac output and myocardial oxygen consumption,101 102 104 106 arrhythmias,101 102 104 106 hypokalemia,101 102 104 hypophosphatemia,101 102 104 gut ischemia,101 102 104 disruption of metabolic and immunologic homeostasis).101 102 104 107 b

CHF

May improve cardiac output and stroke volume and is considered useful in the short-term management of severe CHF that is refractory to cardiac glycosides (digoxin) and diuretics.b

Relative value and role of dopamine versus dobutamine in patients with CHF remain to be clearly established, although dobutamine may be preferred because of pharmacologic and pharmacodynamic differences in chronic CHF.b

Hepatorenal Syndrome

Has been used as part of a regimen for treatment of hepatorenal syndrome; however, long-term beneficial effects have not been demonstrated.b

Cirrhosis

Has been used as part of a regimen for treatment of cirrhosis; however, long-term beneficial effects have not been demonstrated.b

Dopamine Hydrochloride Dosage and Administration

Administration

Usually administer by IV infusion.100 112 a b c

For ACLS during CPR, when IV infusion is not possible, may administer by intraosseous infusion.100 112

Infusion rates used to stimulate cardiac β-adrenergic receptors (i.e., >5 mcg/kg per minute) may be associated with a reduced stimulating effect in infants and patients with chronic CHF.112

IV Infusion

For solution and drug compatibility information, see Compatibility under Stability.

Infuse IV into a large vein, preferably the antecubital vein, using an infusion pump or other apparatus to control the rate of flow and avoid inadvertent administration of a bolus of drug.a b c

Dorsal veins of the hand or ankle should be avoided, if possible, because of the risk of extravasation.a c Such less suitable veins should be used only when the patient's condition requires it, but the site should be switched as soon as possible to a preferred vein.a c Extreme caution if infused into an umbilical artery catheter because of the risk of vasospasm.b c

Avoid extravasation.a b c (See Boxed Warning and also see Extravasation under Cautions.)

A controlled-infusion device, preferably a volumetric pump, should be used; do not administer via an ordinary, gravity-controlled IV administration set.b

If an infusion pump is used with glass containers, pumping action must be discontinued before the container is empty, to prevent an air embolism from residual air being drawn from the container.b

Dopamine in 5% dextrose in flexible containers (e.g., Viaflex) should not be used in series connections.b

When the commercially available IV infusion solution of dopamine in 5% dextrose is used, the accompanying labeling should be consulted for proper methods of administration and other associated precautions.c

Dilution

The concentrate for injection must be diluted prior to administration; alternatively, commercially available diluted injections for IV infusion may be used.b c

The concentration used is individualized according to patient dosage and fluid requirements.b

Dilution of Concentrate for Injection for IV Infusion

Add (volume of concentrate)

of Concentrate (labeled concentration)

to Compatible IV Solution (volume of solution)

to Make (final dilution concentration)

5 mL

40 mg/mL

500 mL

400 mcg/mL

5 mL

40 mg/mL

250 mL

800 mcg/mL

5 mL

80 mg/mL

500 mL

800 mcg/mL

5 mL

80 mg/mL

250 mL

1600 mcg/mL

5 mL

160 mg/mL

500 mL

1600 mcg/mL

5 mL

160 mg/mL

250 mL

3200 mcg/mL

Alternatively, use a commercially available premixed solution (800, 1600, or 3200 mcg/mL).b c

Infusion solution concentrations of 3200 mcg (3.2 mg)/mL are useful when high dosages are required in fluid-restricted patients.b

Rate of Administration

Avoid bolus administration.c

Rate of IV infusion varies according to individual dose requirements titrated to response.100 112 a b c

Shock and CPR: Usually initiate at a rate of 2–5 mcg/kg per minute; increase by 1–4 mcg/kg per minute at 10- to 30-minute intervals until optimal response is attained.b Usual maintenance rate of 20 mcg/kg per minute or less.100 112 b For ACLS during CPR, usually 2–20 mcg/kg per minute.112 For symptomatic bradycardia, usually 2–10 mcg/kg per minute.112

Occlusive vascular disease: Initiate at a rate of 1 mcg/kg per minute or less.b

Severely ill patients: Initiate at a rate of 5 mcg/kg per minute and increase gradually in increments of 5–10 mcg/kg per minute, up to 20–50 mcg/kg per minute; infusion rates >50 mcg/kg per minute have been safely used in advanced states of circulatory decompensation.b

CHF: Initiate at a rate of 0.5–2 mcg/kg per minute.b

Intraosseous Administration

When IV infusion is not possible, may administer by intraosseous infusion for emergency uses such as CPR.100 112

Limit intraosseous administration to personnel well trained in the technique.100

Place a cannula in a noncollapsible marrow venous plexus; such access often can be achieved in 30–60 seconds.100 Use a rigid needle, preferably a specially designed intraosseous or Jamshidi-type bone marrow needle; a styleted needle is preferred to prevent obstruction of the needle with cortical bone.100

Insert the intraosseous needle into the anterior tibial bone marrow; alternatively, the distal femur, medial malleolus, or anterior superior iliac spine can be used.100 In older children and adults, intraosseous cannulas also have been inserted successfully into the distal radius or ulna in addition to the proximal tibia.100

Successful placement outside the hospital (e.g., by emergency medical services) generally is more difficult in older than in younger children.100

Onset of action and systemic concentrations are comparable to those achieved with central venous administration.100 112

Dilution

Same as those for IV infusion. (See Dilution under IV Infusion.)

Rate of Administration

Intraosseous infusion rates are the same as those for IV infusion.100 112 (See Rate of Administration under IV Infusion.)

Administration Risks

Complications are uncommon (less than 1% of patients), and include tibial fracture, lower-extremity compartment syndrome, extravasation, and osteomyelitis; careful technique can minimize the risk.100 Local effects on bone marrow and bone growth appear to be minimal.100 Risk of microscopic pulmonary fat and bone marrow emboli does not appear to be increased.100

Dosage

Rate and duration should be carefully adjusted according to patient response as indicated by heart rate, BP, urine flow, peripheral perfusion, presence of ectopic heartbeats, and, whenever possible, by measurement of central venous or pulmonary wedge pressure and cardiac output.a b c

Weaning patient: It may be necessary to gradually decrease the dose while expanding blood volume with IV fluids to prevent a recurrence of hypotension.a b c Sudden discontinuance can precipitate marked hypotension.a b c In patients who have been receiving moderate to high doses, the final dosage should not be less than 5 mcg/kg per minute in order to avoid hypotension.b

Pediatric Patients

Shock and CPR
IV or Intraosseous

Usually, initiate at a rate of 2–5 mcg/kg per minute; increase by 1–4 mcg/kg per minute at 10- to 30-minute intervals until the optimal response is attained.b

Usual dosage range of 2–20 mcg/kg per minute.100 112

Infusion rates >20 mcg/kg per minute may result in excessive vasoconstriction.112

Once optimal hemodynamic effects have been achieved, the lowest dosage that maintains these effects should be used.b

Adults

Shock and CPR
IV or Intraosseous

Usually, initiate at a rate of 2–5 mcg/kg per minute; increase by 1–4 mcg/kg per minute at 10- to 30-minute intervals until the optimal response is attained.b

Usual dosage range of 2–20 mcg/kg per minute.100 112 Norepinephrine generally is added if dopamine dosages >20 mcg/kg per minute are required to maintain BP during resuscitation.b

Usual dosage range for symptomatic bradycardia is 2–10 mcg/kg per minute; may administer alone or in combination with epinephrine.112

Infusion rates >10–20 mcg/kg per minute may be associated with systemic and splanchnic vasoconstriction.112

Patients with occlusive vascular disease: Initiate at a rate of 1 mcg/kg per minute or less because of risk of local ischemia (e.g., gangrene).b

Severely ill patients: Initiate at a rate of 5 mcg/kg per minute and gradually increased in increments of 5–10 mcg/kg per minute, up to 20–50 mcg/kg per minute; infusion rates exceeding 50 mcg/kg per minute have been safely used in advanced states of circulatory decompensation.b

Once optimal hemodynamic effects have been achieved, the lowest dosage that maintains these effects should be used.b

When adjusting dosage to obtain the desired SBP, optimal dosage for renal response may be exceeded and urine output may decrease.b

Measure urine output frequently for doses >50 mcg/kg per minute.b

Decreased urine flow in the absence of hypotension: Consider reducing the rate of infusion or administering an α-adrenergic blocking agent.b

Disproportionate increase in diastolic pressure: Decrease the rate of infusion and observe the patient carefully for further evidence of predominant vasoconstrictor activity, unless such an effect is desired.b

CHF
IV

Initiate at a rate of 0.5–2 mcg/kg per minute for short-term treatment of severe, refractory, chronic CHF.b If DBP or heart rate increases, the rate of infusion should be decreased.b

Increase dose gradually until urine flow increases.b

Most patients respond adequately to doses of 1–3 mcg/kg per minute.b

Prescribing Limits

Pediatric Patients

Shock and CPR
IV or Intraosseous

Maximum usually is 15–20 mcg/kg per minute, with occasional use as great as 50 mcg/kg per minute.c

Adults

Shock and CPR
IV or Intraosseous

Maximum usually is 50 mcg/kg per minute; although administration rates >50 mcg/kg per minute have been safe in advanced circulatory decompensation states.c

Special Populations

Hepatic Impairment

No specific hepatic dosage recommendations.a However, clearance may be decreased up to 2-fold.c

Renal Impairment

No specific renal dosage recommendations.a However, clearance may be decreased up to 2-fold.c

Geriatric Patients

Not evaluated systematically in those ≥65 years of age, and the manufacturers currently do not make specific dosage recommendations for geriatric patients.b

Initial dosage usually should be at the low end of the range.b

MAO Inhibitor-treated Patients

Initiate dopamine therapy at no greater than 10% of the usual dosage in patients who received an MAO inhibitor within 2–3 weeks prior to dopamine since metabolism will be inhibited.a b c MAO inhibition prolongs and intensifies dopamine effects.a b c

Cautions for Dopamine Hydrochloride

Contraindications

  • Pheochromocytoma or uncorrected tachyarrhythmias or VF.a b c

  • Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products.c

Warnings/Precautions

Warnings

MAO Inhibitors

Patients previously (within 2–3 weeks) treated with MAO inhibitors prior to dopamine administration will require substantially reduced dopamine dosage.a b c (See MAO Inhibitor-treated Patients under Dosage.)

Fluid Overload

IV administration of solutions may cause fluid overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema.c

Hypokalemia

Excess administration of potassium-free solutions may result in hypokalemia.c

Sensitivity Reactions

Sulfites

Some formulations contain sulfites, which may cause allergic-type reactions (including anaphylaxis and life-threatening or less severe asthmatic episodes) in certain susceptible individuals.a b c

Corn

Dextrose-containing solutions may be contraindicated in patients who are sensitive to corn or corn products.c

General Precautions

Monitoring

Monitor ECG, BP, and urine flow and, when possible, cardiac output and pulmonary wedge pressure.b (See Hypovolemia and also Hypoxia, Hypercapnia, and Acidosis.)

Extravasation

Extravasation may cause tissue necrosis and sloughing of surrounding tissues;a b c avoid extravasation.a b c Infuse IV into a large vein.a b c (See Boxed Warning and also see IV Infusion under Administration.)

Carefully monitor the injection site.b

Hypovolemia

Pressor therapy is not a substitute for replacement of blood, plasma, fluids, and/or electrolytes.b Correct blood volume depletion as fully as possible before dopamine therapy is instituted.b

May be used in an emergency as an adjunct to fluid replacement or as a temporary supportive measure to maintain coronary and cerebral artery perfusion until volume replacement can be completed, but dopamine must not be used as sole therapy in hypovolemic patients.b

Additional volume replacement may be required during or after administration of dopamine because of the effects on urine flow.b

Detecting and treating hypovolemia: Monitor central venous pressure or left ventricular filling pressure; in addition, monitor central venous or pulmonary arterial diastolic pressure to avoid overloading the cardiovascular system, diluting serum electrolyte concentrations, and precipitating CHF or pulmonary edema.b

Hypoxia, Hypercapnia, and Acidosis

Must be identified and corrected prior to, or concurrently with, dopamine administration.a b c Can reduce the effectiveness and/or increase the toxicity of dopamine.a c

Vasoconstriction

Decrease or temporarily suspend the rate of infusion if excessive vasoconstriction, decreased urine output, increased heart rate, or an arrhythmia occurs and observe the patient closely.b

If BP or urine output fails to respond to discontinuance, consider administering a short-acting α-adrenergic blocking agent (e.g., phentolamine).b

Hypotension

Infusion rate should be increased rapidly in order to increase BP.b If hypotension persists, discontinue dopamine and administer a drug with greater vasoconstricting properties (e.g., norepinephrine).b

Occlusive Vascular Disease

Carefully monitor patients with a history of occlusive vascular disease (e.g., atherosclerosis, arterial embolism, Raynaud’s disease, cold injury, diabetic endarteritis, or Buerger’s disease) for decreased circulation to the extremities indicated by changes in color or temperature of the skin or pain in the extremities.b

Correct by decreasing the rate of infusion or discontinuing dopamine; however, these changes occasionally have persisted and progressed after discontinuing the drug.b

Consider IV administration of 5–10 mg of phentolamine mesylate if discoloration of the extremities occurs.b

Gangrene of the extremities can occur.b

The potential benefits of continuing dopamine should be weighed against the possible risk of necrosis.b

Ventricular Arrhythmias

Ventricular arrhythmias may occur with very high doses.a b c

Ischemic Heart Disease

Caution in patients with ischemic heart disease.b

Diabetes Mellitus

Caution in administering solutions containing dextrose to patients with known subclinical or overt diabetes mellitus.c

Discontinuing Infusion (Weaning)

When discontinuing an infusion, it may be necessary to decrease the dose of dopamine gradually while expanding blood volume with IV fluids to prevent a recurrence of hypotension.b Sudden cessation of dopamine infusion may result in marked hypotension.b

Specific Populations

Pregnancy

Category C.a c

When administering in ACLS, may decrease blood flow to the uterus; however, the woman must be resuscitated for survival of the fetus.112

If a vasopressor (e.g., dopamine) is used during labor in conjunction with oxytocic drugs, the vasopressor effect may be potentiated and result in severe hypertension.b (See Oxytocics under Interactions.)b

Lactation

Not known whether dopamine is distributed into human milk.b Caution if used in nursing women.b

Pediatric Use

Used in every age group from neonate onward.b

Clearance of dopamine is unpredictable in young children, particularly neonates.c Clearance may be as much as 2-fold greater in those <2 years of age.c

Because of variable, age-dependent clearance, titrate dosage slowly and deliberately, particularly in neonates.c

Neonates may be more sensitive to vasoconstrictive effects.c

Except for vasoconstrictive effects caused by inadvertent infusion of dopamine into the umbilical artery, adverse effects unique to the pediatric population have not been identified, nor have adverse effects identified in adults been found to be more common in pediatric patients.b

Dopamine has been administered at rates as high as 125 mcg/kg per minute in some neonates, but the usual dosage in children has been similar to that in adults on a mcg/kg per minute basis.

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.b

No differences in responses between geriatric and younger patients have been identified.b

Initial usual dosage should be at the low end of the dosage range, and caution should be exercised since renal, hepatic, and cardiovascular dysfunction and concomitant disease or other drug therapy are more common in this age group than in younger adults.b

Common Adverse Effects

Ectopic heartbeats,a b c tachycardia,a b c angina,a b c palpitation,a b c vasoconstriction,a b c hypotension,a b c dyspnea,a b c nausea,a b c vomiting,a b c headache.a b c

Interactions for Dopamine Hydrochloride

Specific Drugs

Drug

Interaction

Comments

α-Adrenergic blocking agents

Peripheral vasoconstriction of high dopamine doses is antagonizeda b c

Extreme caution; propranolol may reverseb

β-Adrenergic blocking agents

Cardiac effects of dopamine are antagonizeda b c

Anesthetics, general

May increase cardiac irritability, resulting in ventricular arrhythmias and hypertension with usual dopamine doses during halogenated hydrocarbon (e.g., halothane) or cyclopropane anesthesiaa b c

Extreme cautiona b c

Antidepressants, tricyclic

Adverse cardiovascular effects may be potentiated by tricyclic antidepressantsa b c

Exercise caution

Butyrophenones (e.g., haloperidol)

Can suppress the dopaminergic renal and mesenteric vasodilation induced with low-dose dopaminea c

Diuretics (e.g., hydrochlorothiazide, furosemide)

Diuretic effects (on urine flow) of low dopamine dosages may be additive with or potentiated by diureticsa b c

Ergonovine

Concomitant use may result in severe hypertensiona b c

Growth hormone (somatropin)

Suppresses pituitary secretionb

MAO inhibitors

Inhibits dopamine metabolism; dopamine effects are prolonged and intensified by MAO inhibitorsa b c

Reduce initial dopamine dosage (dosages no greater than 10% of usual) when MAO inhibitors were used within the previous 2–3 weeksa b c

Phenytoin

Hypotension and bradycardia with IV phenytoinb

Extreme caution, if used at allb

Prolactin

Suppresses pituitary secretionb

Oxytocics

Pressor effect may be potentiated with resultant severe hypertensionb c

Caution if dopamine is used during labor and delivery to correct hypotension or is added to a local anesthetic solutionb

Phenothiazines

Can suppress the dopaminergic renal and mesenteric vasodilation induced with low-dose dopamine infusiona c

Thyrotropin (thyroid-stimulating hormone, TSH)

Suppresses pituitary secretionb

Vasopressors or vasoconstrictors

Concomitant use may result in severe hypertensiona b c

Dopamine Hydrochloride Pharmacokinetics

Absorption

Bioavailability

Rapidly metabolized in the GI tract after oral administration.b

Onset

Within 5 minutes following IV administration.b

Duration

<10 minutes.a b c

Distribution

Extent

Widely distributed but does not cross the blood-brain barrier to a substantial extent.a b c

Apparent volume of distribution in neonates ranges from 0.6–4 L/kg.b

Not known whether dopamine crosses the placenta or is distributed into milk.a b c

Elimination

Metabolism

Via the liver, kidneys, and plasma by MAO and catechol-O-methyltransferase (COMT) to the inactive compounds homovanillic acid (HVA) and 3,4-dihydroxyphenylacetic acid.b

In patients receiving MAO inhibitors, the duration of action of dopamine may be as long as 1 hour.b

About 25% of a dose of dopamine is metabolized to norepinephrine within the adrenergic nerve terminals.b

Elimination Route

In urine principally as HVA and its sulfate and glucuronide conjugates and as 3,4-dihydroxyphenylacetic acid; a very small fraction of a dose is excreted unchanged.b

Half-life

Plasma half-life: About 2 minutes.a b c

Special Populations

Neonates: Elimination half-life of 5–11 minutes.b

Critically ill infants and children: Clearance reportedly ranges from 48–168 mL/kg per minute, with the higher values reported in the younger patients.b

Stability

Storage

Parenteral

Sensitive to and should be protected from light.b

Yellow, brown, or pink to purple discoloration indicates decomposition.b d

Solutions darker than slightly yellow or that are discolored in any other way should not be used, and unused portions should be discarded.b d

Concentrate for Injection for IV Infusion

15–30°C.a

Injection for IV Infusion

25°C; may be exposed briefly to temperatures up to 40°C.a Do not freeze.a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Incompatible with sodium bicarbonate and other alkaline solutions.100 HID a

Avoid contact with oxidizing agents and iron salts.c

Solutions containing dextrose should not be administered through the same administration set as blood since this may result in pseudoagglutination or hemolysis.c

Solution CompatibilityHID

Stable for at least 24 hours in dextrose 5%, dextrose 5% in sodium chloride 0.9%, dextrose 5% in lactated Ringer’s injection, lactated Ringer's, sodium chloride, and sodium lactate (1/6)M.a

Compatible

Amino acids 4.25%, dextrose 25%

Dextrose 5% in Ringer’s injection, lactated

Dextrose 5% in sodium chloride 0.45 or 0.9%

Dextrose 10% in sodium chloride 0.18%

Dextrose 5 or 10% in water

Mannitol 20% in water

Ringer’s injection, lactated

Sodium chloride 0.9%

Sodium lactate (1/6) M

Incompatible

Sodium bicarbonate 5%

Drug Compatibility

Since dopamine dosage must be titrated according to patient response, other drugs generally should not be added to the infusion fluid.b

Additives should not be introduced into the injection container (e.g., Viaflex Plus) of commercially available premixed solutions for IV infusion.b c

Admixture CompatibilityHID

Compatible

Aminophylline

Atracurium besylate

Calcium chloride

Chloramphenicol sodium succinate

Ciprofloxacin

Dobutamine HCl

Enalaprilat

Flumazenil

Heparin sodium

Hydrocortisone sodium succinate

Lidocaine HCl

Meropenem

Methylprednisolone sodium succinate

Nitroglycerin

Oxacillin sodium

Potassium chloride

Ranitidine HCl

Verapamil HCl

Incompatible

Acyclovir sodium

Alteplase

Amphotericin B

Ampicillin sodium

Penicillin G potassium

Sodium bicarbonate100 a

Variable

Gentamicin sulfate

Y-Site CompatibilityHID

Compatible

Alprostadil

Amifostine

Amiodarone HCl

Anidulafungin

Argatroban

Atracurium besylate

Aztreonam

Bivalirudin

Caffeine citrate

Caspofungin acetate

Cefepime HCl

Ceftaroline fosamil

Ceftazidime

Ciprofloxacin

Cisatracurium besylate

Cladribine

Clonidine HCl

Daptomycin

Dexmedetomidine HCl

Diltiazem HCl

Dobutamine HCl

Dobutamine HCl with lidocaine HCl

Dobutamine HCl with nitroglycerin

Dobutamine HCl with sodium nitroprusside

Docetaxel

Doripenem

Doxorubicin HCl liposome injection

Enalaprilat

Epinephrine HCl

Esmolol HCl

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Fentanyl citrate

Fluconazole

Foscarnet sodium

Gemcitabine HCl

Granisetron HCl

Haloperidol lactate

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Hydrocortisone sodium succinate

Hydromorphone HCl

Hydroxyethyl starch 130/0.4 in sodium chloride 0.9%

Labetalol HCl

Levofloxacin

Lidocaine HCl

Lidocaine HCl with dobutamine HCl

Lidocaine HCl with nitroglycerin

Lidocaine HCl with sodium nitroprusside

Linezolid

Lorazepam

Meperidine HCl

Methylprednisolone sodium succinate

Metronidazole

Micafungin sodium

Midazolam HCl

Milrinone lactate

Morphine sulfate

Mycophenolate mofetil HCl

Nicardipine HCl

Nitroglycerin

Nitroglycerin with dobutamine HCl

Nitroglycerin with lidocaine HCl

Nitroglycerin with sodium nitroprusside

Norepinephrine bitartrate

Ondansetron HCl

Oxaliplatin

Pancuronium bromide

Pantoprazole sodium

Pemetrexed disodium

Piperacillin sodium–tazobactam sodium

Potassium chloride

Propofol

Ranitidine HCl

Remifentanil HCl

Sargramostim

Sodium nitroprusside

Sodium nitroprusside with dobutamine HCl

Sodium nitroprusside with lidocaine HCl

Sodium nitroprusside with nitroglycerin

Tacrolimus

Telavancin HCl

Theophylline

Thiotepa

Tigecycline

Tirofiban HCl

Vasopressin

Vecuronium bromide

Verapamil HCl

Warfarin sodium

Zidovudine

Incompatible

Acyclovir sodium

Alteplase

Amphotericin B cholesteryl sulfate complex

Indomethacin sodium trihydrate

Insulin, regular

Sodium bicarbonateb

Variable

Aldesleukin

Furosemide

Actions

  • Stimulates adrenergic receptors of the sympathetic nervous system.b 112

  • Principally a direct stimulatory effect on β1-adrenergic receptors.b

  • Acts on specific dopaminergic receptors in the renal, mesenteric, coronary, and intracerebral vascular beds to cause vasodilation.b

  • Little or no effect on β2-adrenergic receptors.b

  • Main effects depend on the dose administered.b 112 In low doses, cardiac stimulation and renal vascular dilation occur and in larger doses vasoconstriction occurs.b 112

    IV doses of 0.5–2 mcg/kg per minute: acts predominantly on dopaminergic receptors.b

    IV doses of 2–10 mcg/kg per minute: also stimulates β1-adrenergic receptors.b

    Higher therapeutic doses: α-adrenergic receptors are stimulated and the net effect is the result of α-adrenergic, β1-adrenergic, and dopaminergic stimulation.b

  • β1-Adrenergic effects exert a positive inotropic effect on the myocardium and result in an increase in cardiac output because of increased myocardial contractility and stroke volume.b 112

    SBP and pulse pressure may be increased as a result of increased cardiac output; however, peripheral vasodilation and the resulting decrease in peripheral resistance may counteract these effects.b BP, therefore, may remain unchanged or be only slightly elevated.b

    Heart rate is usually not substantially changed.b

    Coronary blood flow and myocardial oxygen consumption usually are increased as a result of increased myocardial contractility.b

  • In low to moderate doses, causes renal and mesenteric vasodilation,b 112 which is presumed to result from an action on dopaminergic receptors.b

  • Renal vasodilation results in increased renal blood flow and GFR.b

    Urine flow is affected variably, but usually increases.b

    In high doses (within and above the therapeutic range), α-adrenergic effects become more prominent and may result in increased peripheral resistance and renal vasoconstriction.b

    This vasoconstriction may decrease previously augmented renal blood flow and urine output.b

    BP may return to normal if hypotension initially existed and may increase to hypertensive levels with excessive doses.b

  • Blood flow to peripheral vascular beds may decrease while mesenteric blood flow is increased because of increased cardiac output; however, with increasing doses, mesenteric blood flow also decreases.b

  • Increases both SBP and DBP in the absence of severe volume depletion because of increased cardiac output and increased peripheral resistance.b

  • Increases or decreases left ventricular filling pressure in patients with CHF.b Heart rate response is variable.b BP may return to normal if hypotension initially existed and may increase to hypertensive levels with excessive doses.b

Advice to Patients

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.a b

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information.a b c (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dopamine Hydrochloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Concentrate, for injection, for IV infusion

40 mg/mL*

Dopamine Hydrochloride for Injection

80 mg/mL*

Dopamine Hydrochloride for Injection

160 mg/mL*

Dopamine Hydrochloride for Injection

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dopamine Hydrochloride in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for IV infusion

0.8 mg/mL Dopamine Hydrochloride (200 or 400 mg) in Dextrose 5%*

0.08% Dopamine Hydrochloride in 5% Dextrose Injection (glass containers; LifeCare; Viaflex Plus)

1.6 mg/mL Dopamine Hydrochloride (400 or 800 mg) in Dextrose 5%*

0.16% Dopamine Hydrochloride in 5% Dextrose Injection (glass containers; LifeCare; Viaflex Plus)

3.2 mg/mL Dopamine Hydrochloride (800 mg) in Dextrose 5%*

0.32% Dopamine Hydrochloride in 5% Dextrose Injection (glass containers; LifeCare; Viaflex Plus)

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions June 20, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2000; 102(Suppl I) I-131-2, I-189, I-328-9.

101. Bellomo R, Chapman M, Finfer S et al. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet. 2000; 356:2139-43. [IDIS 457742] [PubMed 11191541]

102. Galley HF. Renal-dose dopamine: will the message now get through? Lancet. 2000; 356:2112-3.

103. Juste RN, Moran L, Hooper J et al. Dopamine clearance in critically ill patients. Intensive Care Med. 1998; 24:1217-20. [IDIS 421445] [PubMed 9876986]

104. Corwin HL, Lisbon A. Renal dose dopamine: long on conjecture, short on fact. Crit Care Med. 2000; 28:1657-8. [IDIS 448836] [PubMed 10834734]

105. Marik PE, Iglesias J, et al. Low-dose dopamine does not prevent acute renal failure in patients with septic shock and oliguria. Am J Med. 1999; 107:387-90. [IDIS 437296] [PubMed 10527041]

106. Horan JL, Bobek MB, Arroliga AC. Acute renal failure: overview of current and potential therapies. Formulary. 2000; 35:669-80.

107. Mueller BA, Macias WL. Acute Renal Failure. In: DiPiro JT, Talbert RL, Yee GC et al., eds. Pharmacotherapy: a pathophysiologic approach. 4th ed. Stamford: Appleton and Lange; 1999:706-31.

108. Dishart MK, Kellum JA. An evaluation of pharmacological strategies for the prevention and treatment of acute renal failure. Drugs. 2000; 59:79-91. [PubMed 10718100]

109. Ichai C, Soubielle J, Carles M et al. Comparison of the renal effects of low to high doses of dopamine and dobutamine in critically ill patients: a single-blind randomized study. Crit Care Med. 2000; 28:921-8. [IDIS 447545] [PubMed 10809260]

110. Ichai C, Passeron C, Carles M et al. Prolonged low-dose dopamine infusion induces a transient improvement in renal function in hemodynamically stable, critically ill patients: a single-blind, prospective, controlled study. Crit Care Med. 2000; 28:1329-35. [IDIS 448826] [PubMed 10834674]

111. Vovan T, Brenner M. Controversy: is there a “renal dose” dopamine? Crit Care Med. 2000; 28:1220. Editorial.

112. The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I): IV1-211.

pdh. Schilling McCann JA, Publisher. Pharmacists drug handbook. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins and American Society of Health-System Pharmacists; 2003.

HID. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:399-407.

a. American Regent Laboratories, Inc. Dopamine hydrochloride injection, USP prescribing information. Shirley, NY; 2001 Apr.

b. AHFS drug information 2007. McEvoy GK, ed. Dopamine. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1302-5

c. Baxter Healthcare Corporation. Dopamine hydrochloride and 5% dextrose injection, USP prescribing information. Deerfield, IL; 2003 Mar.

d. The United States pharmacopeia, 27th rev, and The national formulary, 22nd ed. Rockville, MD: The United States Pharmacopeial Convention, Inc; 2004:660-1.

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