Dobutamine Side Effects

Please note - some side effects for Dobutamine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Dobutamine - for the Consumer

Dobutamine

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Dobutamine:

Headache; nausea.

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); chest pain; fainting, dizziness, or lightheadedness; fast or irregular heartbeat; pounding in the chest; shortness of breath.

Dobutamine Side Effects - for the Professional

Dobutamine

Increased Heart Rate, Blood Pressure, and Ventricular Ectopic Activity− A 10 to 20 mm increase in systolic blood pressure and an increase in heart rate of 5 to 15 beats/minute have been noted in most patients. Approximately 5% of patients have had increased premature ventricular beats during infusions. These effects are dose related.

Hypotension− Precipitous decreases in blood pressure have occasionally been described in association with Dobutamine therapy. Decreasing the dose or discontinuing the infusion typically results in rapid return of blood pressure to baseline values. In rare cases, however, intervention may be required and reversibility may not be immediate.

Reactions at Sites of Intravenous Infusion− Phlebitis has occasionally been reported. Local inflammatory changes have been described following inadvertent infiltration. Isolated cases of cutaneous necrosis (destruction of skin tissue) have been reported.

Miscellaneous Uncommon Effects− The following adverse effects have been reported in 1% to 3% of patients: nausea, headache, anginal pain, nonspecific chest pain, palpitations, and shortness of breath.

Isolated cases of thrombocytopenia have been reported.

Administration of Dobutamine hydrochloride, like other catecholamines, can produce a mild reduction in serum potassium concentration, rarely to hypokalemic levels.

Longer-Term Safety− Infusions of up to 72 hours have revealed no adverse effects other than those seen with shorter infusions.

Side Effects by Body System

Cardiovascular

Cardiovascular side effects have included hypertension (increases of 50 mm Hg in up to 8% of patients) or hypotension (unusual), increased heart rate (10%), chest pain (8% to 19%), ectopic depolarizations (increased frequency of PVCs in 3% to 15%), and ventricular tachycardia (including rare cases of sustained VT) in approximately 4% of patients. Patients with atrial fibrillation may develop a more rapid ventricular response to dobutamine-induced AV conduction enhancement. Tolerance to the hemodynamic effects of dobutamine may occur after 72 to 96 hours, which may necessitate increased doses. A case of cardiac rupture and death during dobutamine stress testing has been reported. A case of dobutamine-induced complete heart block has also been reported.

Dobutamine rarely has caused ventricular tachycardia. The de novo occurrence of a sustained ventricular tachyarrhythmia during dobutamine infusion has been associated with a significant risk of arrhythmia recurrence of approximately 47%, which can occur in the presence or absence of dobutamine therapy. Reexposure to low-dose dobutamine in patients with hemodynamically stable conditions appears to be relatively safe.

In a study of 20 patients who developed hypotension associated with dobutamine and who underwent cardiac catheterization, 13 were found to have dobutamine-induced wall motion abnormalities. These 13 also had significant coronary artery disease (greater than 70% narrowing in at least one vessel), whereas the 7 who had no drug-induced wall motion abnormalities did not have significant coronary artery disease.

Rare cases of acute myocardial infarction have been associated with dobutamine infusion, including administration during dobutamine stress echocardiography. The mechanism is not known, but may involve alpha-1-mediated coronary vasoconstriction. Limited data suggest that most affected patients have significant underlying coronary artery disease.

A 66-year-old patient with recent myocardial infarction died while undergoing low dose dobutamine stress echocardiography. Baseline characteristics revealed dyskinesia and diastolic thinning of the proximal inferior wall with preserved function. Following an uneventful dosage titration of dobutamine from 4 mcg to 10 mcg, the patient experienced atypical chest pain at the base of the right hemithorax and a new onset pericardial effusion was noted. The patient died despite immediate pericardiocentesis and cardiopulmonary resuscitation.

Dermatologic

Rare cases of scalp pruritus and dermal cellulitis have been associated with the use of dobutamine. These reactions are believed to be due to hypersensitivity to the drug.

Dermatologic side effects are related to administration via a peripheral vein. Extravasation of dobutamine can cause local skin necrosis. For this reason, central venous administration is recommended.

Hypersensitivity

Hypersensitivity reactions, including rash, drug fever, eosinophilia, and bronchospasm have been rarely associated with the use of this drug.

Gastrointestinal

Gastrointestinal side effects include nausea and vomiting in 1% to 3% of patients.

Metabolic

Metabolic changes that have been associated with the use of dobutamine include decreased blood glucose and plasma potassium, and elevated plasma glycerol and free fatty acid concentrations. (Dobutamine stimulates insulin secretion and is lypolytic.)

Nervous system

Nervous system side effects, such as paresthesias and lightheadedness, have been reported in patients after inadvertently receiving high doses of dobutamine. In a study using dobutamine during stress echocardiography, anxiety was reported in 6%, headache in 4%, and tremors in 4% of patients. Myoclonus has also been associated with dobutamine administration in patients with renal insufficiency.

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