Dobutamine Hydrochloride

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

Trade Names

Dobutamine Hydrochloride
- Injection, concentrate 12.5 mg/mL

Dobutamine Hydrochloride in Dextrose 5%
- Injection 250 mg per 250 mL (1 mg/mL)
- Injection 500 mg per 500 mL (1 mg/mL)
- Injection 500 mg per 250 mL (2 mg/mL)
- Injection 1,000 mg per 250 mL (4 mg/mL)

Pharmacology

Stimulates beta-1 receptors in the 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; dobutamine with dextrose should not be administered simultaneously with blood through the same infusion set because of the possibility of pseudoagglutination of red cells.

Dosage and Administration

Adults and Children

IV infusion Initial dose of 0.5 to 1 mcg/kg/min; titrate every few min to desired response. Usual dosage is 2 to 20 mcg/kg/min, with rates up to 40 mcg/kg/min rarely used.

General Advice

Administer by IV infusion only. Not for IV bolus. Use electronic infusion device to monitor infusion rate.
Conventional vials must be diluted prior to administration. Dilute 20 mL vial in at least 50 mL of diluent; dilute 40 mL vial in at least 100 mL of diluent.
Adjust dosage based on BP, urine flow, frequency of ectopic activity, heart rate, and, whenever possible, measurements of cardiac output, central venous pressure, and/or pulmonary capillary wedge pressure.
Solution may have pink color because of slight oxidation, but this effect does not indicate loss of potency.
Chemically incompatible with alkaline solutions (eg, sodium bicarbonate) because drug is inactivated.
Solutions containing dextrose should not be administered through the same administration set as blood.

Storage/Stability

Store between 59° and 86°F. Avoid excessive heat. Protect from freezing. Use IV solutions within 24 h after dilution.

Drug Interactions

Beta-blockers

Based on animal studies, beta-blockers may antagonize beta receptor–stimulating activity of dobutamine. Monitor the clinical response of the patient.

Catechol-O-methyl transferase (COMT) inhibitors (eg, entacapone, tolcapone)

Coadministration of dobutamine and COMT inhibitors may result in inhibition of the pathway responsible for normal catecholamine metabolism. Excessive sympathetic stimulation may result. Use with caution. Close clinical monitoring for signs of excessive sympathetic activity is indicated.

Cimetidine

Pharmacologic effects of dobutamine may be increased. Monitor BP. If an interaction is suspected, decrease the dosage of dobutamine.

Desflurane

May increase risk of arrhythmias by sensitizing cardiac tissue to sympathomimetic agents. Closely monitor the clinical response of the patient.

Methyldopa, nitroprusside, rauwolfia alkaloids (eg, reserpine)

Hypertension may result. Closely monitor BP. If an interaction is suspected, be prepared to discontinue dobutamine or administer phentolamine.

Linezolid

Pharmacologic effects of dobutamine may be increased by linezolid. Headache, hyperpyrexia, and hypertension may occur. Coadministration of dobutamine and linezolid is not recommended without careful monitoring for increases in BP. If coadministration is considered necessary, the initial dose of dobutamine should be reduced and titrated to desired effect. If severe hypertension occurs, give phentolamine or another alpha-adrenergic blocker.

Oxytocic drugs (eg, ergonovine, oxytocin)

Coadministration may result in hypertension. The incidence of hypertension decreases when dobutamine is not used prior to administration of the oxytocic drug.

Tricyclic antidepressants

May potentiate effect of dobutamine; use combination with caution. Closely monitor patients for dysrhythmias and hypertension. Adjust the dobutamine dose as needed.

Adverse Reactions

Cardiovascular

Increased premature ventricular beats (dose-related) (5%); anginal 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%).

GI

Nausea (1% to 3%).

Hematologic

Thrombocytopenia.

Local

Cutaneous necrosis; inflammation after inadvertent infiltration; phlebitis.

Respiratory

Shortness of breath (1% to 3%).

Miscellaneous

Nonspecific chest pain (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

In premature neonates, dobutamine may be less effective than dopamine in raising BP without causing undue tachycardia.

Hypersensitivity

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

Special Risk Patients

Use with extreme caution after MI and in patients with known subclinical or overt diabetes mellitus. Avoid use in uncorrected hypovolemic states unless used as a temporary emergency measure to maintain coronary and cerebral flow. No improvement may be observed in the presence of marked mechanical obstruction (eg, severe valvular aortic stenosis).

Sulfite Sensitivity

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

CV effects

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

Fluid overload

May cause fluid and/or solute overloading.

Hypokalemia

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

Overdosage

Symptoms

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