Skip to Content

DOBUTamine

Pronunciation

Pronunciation

(doe BYOO ta meen)

Index Terms

  • Dobutamine HCl
  • Dobutamine HCl/D5W
  • Dobutamine Hydrochloride

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous, as hydrochloride:

Generic: 1 mg/mL (250 mL); 2 mg/mL (250 mL); 4 mg/mL (250 mL); 250 mg/20 mL (20 mL); 500 mg/40 mL (40 mL)

Pharmacologic Category

  • Adrenergic Agonist Agent
  • Inotrope

Pharmacology

Dobutamine, a racemic mixture, stimulates myocardial beta1-adrenergic receptors primarily by the (+) enantiomer and some alpha1 receptor agonism by the (-) enantiomer, resulting in increased contractility and heart rate, and stimulates both beta2- and alpha1-receptors in the vasculature. Although beta2 and alpha1 adrenergic receptors are also activated, the effects of beta2 receptor activation may equally offset or be slightly greater than the effects of alpha1 stimulation, resulting in some vasodilation in addition to the inotropic and chronotropic actions (Leier 1988; Majerus 1989; Ruffolo 1987). Lowers central venous pressure and wedge pressure, but has little effect on pulmonary vascular resistance (Leier 1977; Leier 1978).

Metabolism

In tissues and hepatically to inactive metabolites

Excretion

Urine (as metabolites)

Onset of Action

IV: 1-10 minutes; Peak effect: 10-20 minutes

Half-Life Elimination

2 minutes

Use: Labeled Indications

Cardiac decompensation: Short-term management of patients with cardiac decompensation

American College of Cardiology/American Heart Association heart failure (HF) guideline recommendations (ACCF/AHA [Yancy 2013]): To maintain systemic perfusion and preserve end-organ performance in patients with cardiogenic shock; bridge therapy in stage D HF unresponsive to guideline-directed medical therapy and device therapy in patients awaiting heart transplant or mechanical circulatory support; short-term management of hospitalized patients with severe systolic dysfunction presenting with low blood pressure and significantly depressed cardiac output; long-term management (palliative therapy) in select patients with stage D HF unresponsive to guideline-directed medical therapy and device therapy who are not candidates for heart transplant or mechanical circulatory support.

Off Label Uses

Advanced life support

Based on the American Heart Association (AHA) guidelines for post cardiac arrest care in adults and the AHA guidelines for pediatric advanced life support, the use of dobutamine during the post-resuscitation phase of cardiac arrest may be used for inotropic support.

Myocardial dysfunction related to sepsis (positive inotropic agent)

Data from a number of clinical trials in patients with septic shock supports the use of dobutamine in the treatment of this condition [Beale 2004], [De Backer 1993], [De Backer 1994], [Gutierrez 1994], [Hollenberg 2004], [Jardin 1981], [Martin 1990], [Vallet 1993]. Septic patients who have been adequately fluid resuscitated and have an adequate mean arterial pressure but low cardiac index (<2.5 L/minute/m2) may require dobutamine. Dobutamine may help reverse tissue hypoperfusion by increasing cardiac output.

Based on the Surviving Sepsis Campaign International Guidelines for the Management of Severe Sepsis and Septic Shock, a trial of dobutamine infusion should be given or added to vasopressor therapy (if in use) if persistent signs of hypoperfusion (eg, SCVO2 is <70% or SVO2 <65%) exist (despite adequate intravascular volume repletion and adequate MAP) or anytime when myocardial dysfunction is present with the goal of normalizing cardiac output. Caution should be used in the sepsis population, as increasing doses of dobutamine may decrease blood pressure. Using dobutamine to increase cardiac index to supranormal levels is not recommended.

Stress echocardiography (diagnostic agent)

Data from a number of clinical studies evaluating the use of dobutamine infusion during stress echocardiography for detecting coronary artery disease supports the use of dobutamine infusion as a diagnostic agent in patients who are incapable of physical exercise or who have contraindications (eg, bronchospastic airway disease) to pharmacologic vasodilator stressors. Wall motion abnormalities developing with increasing doses of dobutamine may help to identify ischemic and/or hibernating myocardium [Fragasso 1999], [Marcovitz 1992], [Previtali 1991].

Based on the American Society of Nuclear Cardiology, dobutamine infusion administered as a secondary pharmacologic stressor is an effective and recommended alternative agent to detect obstructive coronary disease.

Contraindications

Hypersensitivity to dobutamine or sulfites (some contain sodium metabisulfate), or any component of the formulation; hypertrophic cardiomyopathy with outflow tract obstruction (formerly known as idiopathic hypertrophic subaortic stenosis [IHSS])

Note: When utilized for stress testing, additional contraindications according to the American Society of Nuclear Cardiology (ASNC) include patients with recent (<1 week) MI, unstable angina, severe aortic stenosis, atrial tachyarrhythmias with uncontrolled ventricular response, prior history of ventricular tachycardia, uncontrolled hypertension (>200/110 mm Hg), aortic dissection or large aortic aneurysm, and patients on beta blockers where heart rate and inotropic responses to dobutamine will be attenuated (ASNC [Henzlova 2009])

Dosing: Adult

Cardiac decompensation: IV infusion:

Initial dose: 0.5 to 1 mcg/kg/minute (per the manufacturer); may also initiate at higher doses (eg, 2.5 mcg/kg/minute) depending on severity of decompensation with titration to desired response (Leier 1977).

Maintenance dose: 2 to 20 mcg/kg/minute. Note: In patients with heart failure, lower doses are preferred to minimize adverse effects (ACCF/AHA [Yancy 2013]).

Maximum dose: 40 mcg/kg/minute. The ACCF/AHA 2013 heart failure guidelines and the Surviving Sepsis Campaign recommend a maximum dose of 20 mcg/kg/minute (ACCF/AHA [Yancy 2013]; SCCM [Dellinger 2013]).

Adult Advanced Cardiovascular Life Support (ACLS) guideline recommendation (in the immediate post-cardiac arrest care setting): IV infusion: Initial: 5 to 10 mcg/kg/minute; titrate to effect (AHA [Peberdy 2010])

Stress echocardiography (diagnostic agent) (off-label use): IV infusion: Initial: 5 to 10 mcg/kg/minute; increase at 3-minute intervals to 20 mcg/kg/minute, then 30 mcg/kg/minute, and then 40 mcg/kg/minute. May coadminister atropine in patients who do not achieve target heart rate (ASNC [Henzlova 2009]).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Cardiac decompensation: Refer to adult dosing.

Pediatric Advanced Life Support (PALS) guideline recommendation (to maintain cardiac output and for postresuscitation stabilization): IV or I.O.: Dose range: 2 to 20 mcg/kg/minute (AHA [Kleinman 2010]).

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Administration

Always administer via infusion device; administer into large vein.

Storage

Stability of parenteral admixture at room temperature (25°C) is 48 hours; at refrigeration (4°C) stability is 7 days. Remix solution every 24 hours. Pink discoloration of solution indicates slight oxidation but no significant loss of potency.

Drug Interactions

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Calcium Salts: May diminish the therapeutic effect of DOBUTamine. Monitor therapy

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Exceptions: Cannabidiol. Monitor therapy

Cocaine: May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Consider therapy modification

COMT Inhibitors: May decrease the metabolism of COMT Substrates. Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Monitor therapy

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Monitor therapy

Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Avoid combination

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Consider therapy modification

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Monitor therapy

Adverse Reactions

Incidence of adverse events is not always reported.

Cardiovascular: Ventricular premature contractions (5%; dose related), angina pectoris (1% to 3%), chest pain (1% to 3%; nonspecific), palpitations (1% to 3%), hypotension, increased blood pressure, increased heart rate, localized phlebitis, ventricular ectopy (increased)

Central nervous system: Headache (1% to 3%), paresthesia

Dermatologic: Skin necrosis (isolated cases)

Endocrine & metabolic: Decreased serum potassium (slight)

Gastrointestinal: Nausea (1% to 3%)

Hematologic & oncologic: Thrombocytopenia (isolated cases)

Local: Local inflammation, local pain (from infiltration)

Neuromuscular & skeletal: Leg cramps (mild)

Respiratory: Dyspnea (1% to 3%)

Miscellaneous: Fever (1% to 3%)

Warnings/Precautions

Concerns related to adverse effects:

• Arrhythmias: Ventricular arrhythmias, including nonsustained ventricular tachycardia and supraventricular arrhythmias, have been reported (Tisdale,1995). Observe closely for arrhythmias in patients with acute heart failure; sudden cardiac death has been observed (O’Connor 1999; Pickworth 1992; Young 2000). Ensure that ventricular rate is controlled in atrial fibrillation/flutter before initiating; may increase ventricular response rate. In heart transplant candidates, institute appropriate measures to protect patient against risks of sudden cardiac death (Young 2000).

• Blood pressure effects: An increase in blood pressure is more common due to augmented cardiac output, but occasionally a patient may become hypotensive.

• Heart failure complications: An increased risk of hospitalization and death has been observed with prolonged use in New York Heart Association Class III/IV heart failure patients (O’Connor 1999).

• Tachycardia: May cause dose-related increases in heart rate.

• Ventricular ectopy: May exacerbate ventricular ectopy (dose-related).

Disease-related concerns:

• Aortic stenosis: Ineffective therapeutically in the presence of mechanical obstruction such as severe aortic stenosis.

• Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy to minimize the risk of arrhythmias (ACC/AHA/ESC [Zipes 2006]; Tisdale 1995).

• Hypovolemia: If needed, correct hypovolemia first to optimize hemodynamics.

• Active myocardial ischemia/myocardial infarction (post): Use with caution in patients with active myocardial ischemia or recent myocardial infarction; can increase myocardial oxygen demand.

Concurrent drug therapy issues:

• Monoamine oxidase inhibitors (MAO-I): Use with extreme caution in patients taking MAO inhibitors; prolong hypertension may result from concurrent use.

Dosage form specific issues:

• Sodium sulfite: Product may contain sodium sulfite.

Special populations:

• Elderly: Use with caution in the elderly; start at lower end of the dosage range.

Other warnings/precautions:

• Long-term therapy: According to the ACCF/AHA 2013 heart failure guidelines, long-term use of intravenous inotropic therapy without a specific indication or for reasons other than palliation is potentially harmful (ACCF/AHA [Yancy 2013]).

Monitoring Parameters

Blood pressure, ECG, heart rate, CVP, RAP, MAP; serum glucose, renal function; urine output; if pulmonary artery catheter is in place, monitor CI, PCWP, and SVR; ScvO2 or SvO2

Consult individual institutional policies and procedures.

Pregnancy Risk Factor

B

Pregnancy Considerations

Adverse events have not been observed in animal reproduction studies. Dobutamine should not be used as a diagnostic agent during stress testing in pregnant women (Regitz-Zagrosek 2011). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant woman. Appropriate medications should not be withheld due to concerns of fetal teratogenicity. Dobutamine use during the post-resuscitation phase may be considered; however, the effects of inotropic support on the fetus should also be considered. Doses and indications should follow current Advanced Cardiovascular Life Support (ACLS) guidelines (Jeejeebhoy [AHA] 2015).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber shortness of breath, tachycardia, abnormal heartbeat, severe dizziness, passing out, injection site pain or irritation, or severe headache (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

Hide