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Dobutamine Hydrochloride

Pronunciation: (doe-BUE-ta-meen HYE-droe-KLOR-ide)
Class: Vasopressor

Trade Names:
Dobutamine Hydrochloride
- Injection 12.5 mg/mL

Pharmacology

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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

Half-life 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; hypersensitivity to any component of the product.

Dosage and Administration

Adults

IV infusion 2.5 to 15 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 2 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

Store at 59° to 86°F. Avoid excessive heat. Protect from freezing. For pharmacy bulk packages, discard any unused portion within 4 h after initial closure entry. Use IV solutions within 24 h after dilution.

Drug Interactions

Beta-blockers

May antagonize beta receptor–stimulating activity of dobutamine.

Furazolidone, methyldopa, nitroprusside, 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 premature ventricular beats (5%); anginal pain, nonspecific chest pain, palpitations (1% to 3%); decreased BP; exaggerated chronotropic and pressor effects; increased BP; increased heart rate; increased ventricular ectopic activity.

CNS

Headache (1% to 3%).

Dermatologic

Cutaneous necrosis.

GI

Nausea (1% to 3%).

Hematologic

Thrombocytopenia.

Local

Inflammation after inadvertent infiltration; phlebitis.

Respiratory

Shortness of breath (1% to 3%).

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. Consider monitoring serum potassium.

Pregnancy

Category B .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Hypersensitivity

Reactions suggestive of hypersensitivity, including skin rash, fever, eosinophilia, and bronchospasm, have been reported.

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 patients; 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.

Hyperkalemia

Mild reduction in serum potassium, rarely to hyperkalemic levels, may occur.

Hypokalemia

Mild hypokalemia may occur.

Overdosage

Symptoms

Anginal and nonspecific chest pain, anorexia, anxiety, headache, hypertension, hypotension, MI, nausea, palpitations, shortness of breath, tachyarrhythmias, tremor, ventricular fibrillation, vomiting.