Dopamine Hydrochloride

Pronunciation

Pronunciation: DOE-pa-meen HYE-droe-KLOR-ide
Class: Vasopressor

Trade Names

Dopamine Hydrochloride
- Injection 40 mg/mL
- Injection 80 mg/mL
- Injection 160 mg/mL

Dopamine Hydrochloride in Dextrose 5%
- Injection 200 mg per 250 mL (0.8 mg/mL)
- Injection 400 mg per 500 mL (0.8 mg/mL)
- Injection 400 mg per 250 mL (1.6 mg/mL)
- Injection 800 mg per 500 mL (1.6 mg/mL)
- Injection 800 mg per 250 mL (3.2 mg/mL)

Pharmacology

Stimulates beta-1 receptors in the heart, causing more complete and forceful contractions (inotropy). Also acts on alpha receptors (dose dependent) and has dopaminergic effects.

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Pharmacokinetics

Distribution

Widely distributed; does not cross the blood-brain barrier to a significant extent.

Metabolism

Metabolized in the liver, kidney, and plasma by MAO and catechol-O-methyltransferase to inactive compounds. Approximately 25% of dose is taken up in the adrenergic nerve terminals where it is hydrolyzed to norepinephrine.

Elimination

Half-life approximately 2 min.

Approximately 80% excreted in the urine within 24 h as metabolites; a very small amount excreted unchanged.

Onset

Within 5 min.

Duration

Less than 10 min.

Indications and Usage

Correction of hemodynamic imbalances present in shock syndrome after MI, trauma, endotoxic septicemia, open heart surgery, and renal failure or chronic cardiac decompensation (eg, CHF).

Unlabeled Uses

Calcium channel blocker or beta-blocker overdose; drug-induced hypovolemic shock; treatment of RDS in infants; COPD; CHF.

Contraindications

Pheochromocytoma; uncorrected tachyarrhythmias; ventricular fibrillation; allergy to corn/corn products (dextrose solutions).

Dosage and Administration

Adults and Children

IV Initial dose of 2 to 5 mcg/kg/min with incremental changes of 5 to 10 mcg/kg/min gradually until adequate response is noted. Most patients are maintained at less than 20 mcg/kg/min. If dosage exceeds 50 mcg/kg/min, assess renal function frequently.

General Advice

  • Administer by IV infusion only, preferably into a large vein. Metering device is essential for controlling rate of flow.
  • Administration into an umbilical artery catheter is not recommended.
  • Dopamine is potent drug. Dilute before use if not prediluted.
  • Do not use if solution is discolored.
  • Chemically incompatible with alkaline solutions, including sodium bicarbonate or other alkaline IV solutions (dopamine is inactivated).
  • Do not mix dopamine in the same container with alteplase because particulate matter has been observed.
  • Do not add dopamine to amphotericin B solutions because amphotericin B is physically unstable in dopamine-containing solutions.
  • When appropriate, increase blood volume with whole blood or plasma.
  • If a marked decrease in pulse pressure and disproportionate increase in diastolic BP are observed, the rate of infusion should be decreased and the patient monitored for further evidence of predominant vasoconstrictive activity, unless such an effect is desired.
  • If an increased number of ectopic beats are observed, the dose should be reduced if possible.
  • Chemically incompatible with alkaline solutions (drug is inactivated). Avoid contact with oxidizing agents or iron salts.

Storage/Stability

Store at 68° to 77°F. Avoid excessive heat. Protect from freezing. Dilute just prior to administration. Solution is stable for 24 h after dilution.

Drug Interactions

Alpha-blockers

May antagonize peripheral vasoconstriction caused by high-dose dopamine.

Beta-blockers (eg, metoprolol, propranolol)

May antagonize the cardiac effects of dopamine.

Cyclopropane, halogenated hydrocarbons

May sensitize the myocardium to the action of dopamine. Use with extreme caution.

Diuretics

May produce an additive or potentiating effect on urine flow.

Furazolidone, methyldopa, reserpine

Hypertension may result.

Guanethidine

Antihypertensive effects of guanethidine may be negated.

Haloperidol, phenothiazines (eg, chlorpromazine)

May suppress the dopaminergic renal and mesenteric vasodilation produced with low-dose dopamine infusion.

MAOIs

May greatly increase pressor response from dopamine.

Oxytocic agents, vasoconstrictors (eg, ergonovine), vasopressors

Severe hypertension may occur.

Phenytoin

Severe hypotension and bradycardia may result after coadministration with dopamine.

Tricyclic antidepressants

May decrease pressor response from dopamine.

Laboratory Test Interactions

Infusion of dopamine suppresses pituitary secretion of TSH, growth hormone, and prolactin.

Adverse Reactions

Cardiovascular

Anginal pain, bradycardia, cardiac conduction abnormalities, ectopic beats, hypertension, hypotension, palpitation, tachycardia, vasoconstriction, ventricular arrhythmia, widened QRS complex.

CNS

Anxiety, headache.

GI

Nausea, vomiting.

Miscellaneous

Azotemia, dyspnea, gangrene of the extremities, peripheral cyanosis, piloerection.

Precautions

Warnings

Antidote for peripheral ischemia

To prevent sloughing and necrosis, infiltrate the area as soon as possible with 10 to 15 mL of sodium chloride 0.9% injection containing phentolamine 5 to 10 mg (0.1 to 0.2 mg/kg; max, 10 mg/dose for children).


Monitor

Monitor vital signs and ECG closely throughout therapy. Monitor I&O regularly; note decreases in urine output. Monitor CVP or pulmonary wedge pressure if possible during infusion. Note significant changes in vital signs, ECG changes, deterioration of peripheral pulses, and/or cold, mottled extremities. Closely monitor urine flow, cardiac output, and BP during dopamine infusion. Acidosis, hypercapnia, hypoxia, and hypovolemia must be identified and corrected prior to or concurrent with dopamine administration. Closely monitor patients with a history of occlusive vascular disease (eg, atherosclerosis, arterial embolism, Raynaud disease, cold injury, diabetic endarteritis, Buerger disease) for any change in color or skin temperature of the extremities. Monitoring CVP or left ventricular filling pressure may be useful in detecting and treating hypovolemia.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established for dopamine injection; dopamine in dextrose injection has been used in patients from birth onwards.

Elderly

Use with caution, usually starting at the low end of the dosage range, because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.

Sulfite Sensitivity

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

Discontinuation

When discontinuing the dopamine infusion, it may be necessary to gradually decrease the dose while expanding blood volume. Sudden cessation may result in marked hypotension.

Diabetes

Use solutions containing dextrose with caution in patients with known and subclinical or overt diabetes.

Hypotension

If hypotension occurs at low infusion rates, rapidly increase the infusion rate until an adequate BP is obtained. If hypotension persists, discontinue dopamine and administer a more potent vasoconstrictor (eg, norepinephrine).

Extravasation

Avoid by infusing into large vein and monitoring infusion carefully.

Fluid and electrolyte balance

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

Hypovolemia

Should be avoided. Prior to starting therapy, correct hypovolemia.

Overdosage

Symptoms

Hypertension.

Patient Information

  • Instruct patient to inform health care provider immediately if these signs occur: chest pain, discomfort at IV site, dyspnea, numbness, tingling or burning of extremities.

Copyright © 2009 Wolters Kluwer Health.

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