Dobutamine Side Effects
Some side effects of dobutamine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to dobutamine: parenteral concentrate for injection for iv infusion, parenteral injection for iv infusion
Side effects include:
Ectopic heartbeats, increased heart rate, elevations in BP, hypotension, phlebitis, local inflammatory changes.
For Healthcare Professionals
Applies to dobutamine: intravenous solution
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.
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 reactions, including rash, drug fever, eosinophilia, and bronchospasm have been rarely associated with the use of this drug.
Gastrointestinal side effects include nausea and vomiting in 1% to 3% of patients.
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 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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