Adult: As short-term treatment of patients with cardiac decompensation due to depressed contractility resulting from decompensated heart failure, cardiogenic or septic shock, cardiomyopathies and cardiac surgeries: Usual dose range: 2.5-10 mcg/kg/min via continuous IV infusion using an infusion device; adjusted according to individual response (as measured by blood pressure, heart rate, cardiac and urine output, central venous and pulmonary capillary wedge pressure). Doses as low as 0.5 mcg/kg/min up to 40 mcg/kg/min may be required in some cases. Recommendations may vary among individual products and countries (refer to local detailed guidelines). Child: Infants and children Initially, 0.5-1 mcg/kg/min given via continuous IV infusion using an infusion device, titrated gradually every few minutes to a usual dose range of 2-20 mcg/kg/min according to individual response. Alternatively, an initial dose of 5 mcg/kg/min via continuous IV infusion may be used, then adjusted to 2-20 mcg/kg/min based on clinical response. Doses are diluted up to a Max concentration of 5,000 mcg/mL. Administration via a central line is preferred. Recommendations may vary among individual products and countries (refer to local detailed guidelines).
Intravenous Stress echocardiography
Adult: As an alternative to physical exercise: Initially, 5 mcg/kg/min, increased every 3 minutes to 10 mcg/kg/min, then 20 mcg/kg/min, then 30 mcg/kg/min, and then 40 mcg/kg/min until a diagnostic endpoint is achieved. Doses are given via continuous IV infusion. Consider co-administration with atropine if no diagnostic endpoint is reached. Dosing discontinuation may be required according to individual diagnostic endpoints (refer to detailed product guidelines).
Reconstitution
Concentrated solution for infusion: Adults and children: Dilute with dextrose 5% inj or other compatible IV fluids (e.g. dextrose 10% inj, dextrose 5% and NaCl 0.45% inj, NaCl 0.9% solution) up to a Max concentration of 5,000 mcg/mL. Neonates: Dilute with dextrose 5% inj or other compatible IV solutions to a standard concentration of 2,000 mcg/mL. Refer to local detailed product guidelines for the rates of infusion based on concentration and further compatible infusion fluids.
Incompatibility
Incompatible with alkaline solutions (e.g. Na bicarbonate), aminophylline, aciclovir, alteplase, bretylium, Ca chloride, Ca gluconate, cefalotin, cefazolin, diazepam, digoxin, furosemide, etacrynic acid, bumetanide, insulin, heparin, warfarin, Mg sulfate, K chloride, hydrocortisone Na succinate, penicillin, phenytoin, thiopental Na, streptokinase, verapamil, and solutions containing both Na metabisulfite and ethanol.
Contraindications
Mechanical obstruction affecting ventricular filling and/or outflow, such as constrictive pericarditis, pericardial tamponade, severe aortic stenosis, and hypertrophic cardiomyopathy with outflow tract obstruction (previously known as idiopathic hypertrophic subaortic stenosis [IHSS]); phaeochromocytoma. Additional contraindications when used for stress echocardiography: Recent MI (within 30 days), unstable angina, main left coronary artery stenosis, haemodynamically significant cardiac valvular defect, severe heart failure (NYHA class III or IV), patients at risk for or with a medical history of clinically significant or chronic arrhythmia (especially recurrent persistent ventricular tachycardia), uncontrolled arrhythmia including uncontrolled aortic dissection and aneurysm, inadequately treated or uncontrolled arterial hypertension, hypovolaemia, poor sonographic imaging conditions; acute pericarditis, myocarditis or endocarditis.
Special Precautions
Patient with active myocardial ischaemia, recent MI, cardiogenic shock complicated by severe hypotension, atrial fibrillation, arterial hypertension; electrolyte imbalance, diabetes mellitus, hyperthyroidism. Withhold antianginal therapy for 12 hours prior to dobutamine stress echocardiography. Elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Increased systolic blood pressure and heart rate, ventricular arrhythmias (e.g. non-sustained ventricular tachycardia, ventricular fibrillation, supraventricular arrhythmia), precipitation or exacerbation of ventricular ectopic activity (dose-related), hypotension secondary to vasodilation; hypersensitivity reactions (e.g. fever, skin rash, eosinophilia, bronchospasm); drug tolerance (when infused continuously for >72 hours). Stress cardiomyopathy (when used during cardiac stress testing). Blood and lymphatic system disorders: Platelet aggregation inhibition (prolonged administration). Cardiac disorders: Angina pectoris, palpitation, chest pain, coronary artery spasm. Gastrointestinal disorders: Nausea. General disorders and administration site conditions: Localised phlebitis at inj site, local inflammation. Investigations: ECG ST segment elevation. Metabolism and nutrition disorders: Rarely, hypokalaemia. Nervous system disorders: Headache, paraesthesia, tremor, myoclonic spasm. Renal and urinary disorders: Increased urinary urgency (high doses). Respiratory, thoracic and mediastinal disorders: Dyspnoea, asthma. Skin and subcutaneous tissue disorders: Exanthema. Vascular disorders: Hypertension. Potentially Fatal: Rarely, acute cardiac rupture (when used during cardiac stress testing).
Correct hypovolaemia before and throughout treatment. Closely monitor blood pressure, heart rate, ECG, cardiac output, haemodynamic parameters (e.g. central venous pressure, pulmonary capillary wedge pressure, mean arterial pressure), urine output and infusion rate. Obtain renal function test, electrolytes (e.g. serum K level), and blood glucose. When used for stress echocardiography: Continuously monitor all wall areas via echocardiography, ECG, and blood pressure.
Overdosage
Symptoms: Headache, nausea, vomiting, anorexia, anxiety, tremor, palpitation, shortness of breath, anginal pain, and non-specific chest pain. Hypotension, supraventricular or ventricular arrhythmia, ventricular fibrillation and myocardial ischaemia may also occur. Management: Establish airway and ensure oxygenation and ventilation. Carry out resuscitation procedures immediately. Closely monitor vital parameters and maintain the balance of blood gases and serum electrolytes. Administer lidocaine or propranolol for severe ventricular arrhythmias. Treat angina with sublingual nitrates or using shot-active β-blockers (e.g. esmolol). Reduce the dose or terminate the IV infusion if a hypertensive reaction occurs.
Drug Interactions
Sympathomimetic effect may be diminished by β-blockers (e.g. propranolol, metoprolol). May result in a greater increase in cardiac output when given with venous-acting vasodilators (e.g. Na nitroprusside, nitrates). May cause a more distinct increased pressure and decreased/no change of ventricular filling pressure when given with dopamine. May increase myocardial excitability and the risk of ventricular extrasystoles with inhaled anaesthetics (e.g. halogenated anaesthetics, cyclopropane). Effects may be enhanced by entacapone. May cause prolonged hypertension and increased incidence of arrhythmias with MAOIs. Concomitant use of high dobutamine doses with ACE inhibitors (e.g. captopril) may cause increased cardiac output accompanied by elevated myocardial oxygen consumption. Co-administration with antianginal therapy may result in less pronounced or non-existent ischaemic reactions (when used for stress echocardiography).
Action
Description: Mechanism of Action: Dobutamine is a sympathomimetic agent that is structurally similar to dopamine. It directly stimulates myocardial β1-adrenergic receptors mainly by the (+) enantiomer and some α1 receptors by the (-) enantiomer, thereby leading to increased myocardial contractility and heart rate. It also has a mild agonist effect on β2- and α1-adrenergic receptors resulting in minimal activity to systemic vasculature. Onset: Within 2 minutes. Pharmacokinetics: Absorption: Time to peak plasma concentration: 10 minutes. Distribution: Volume of distribution: 0.2 L/kg. Metabolism: Metabolised in tissues and the liver by COMT into 3-O-methyldobutamine (major inactive metabolite) and via conjugation into glucuronic acid. Excretion: Mainly via urine, as metabolites; faeces (small amounts). Plasma elimination half-life: Approx 2-3 minutes.
Chemical Structure
Dobutamine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 36811, Dobutamine. https://pubchem.ncbi.nlm.nih.gov/compound/Dobutamine. Accessed Aug. 18, 2023.
Storage
Store between 20-25°C. Do not refrigerate or freeze. Protect from light. Diluted solutions: Stable for 24 hours when stored at 25°C. May exhibit a pink discolouration that may become darker over time due to slight oxidation (this causes no significant loss of potency).
C01CA07 - dobutamine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
References
Anon. Dobutamine (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/05/2023.Anon. Dobutamine. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 04/05/2023.Anon. Dobutamine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 04/05/2023.Buckingham R (ed). Dobutamine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/05/2023.Dobutamine 12.5 mg/mL, Concentrate for Solution for Infusion (Hikma Farmacêutica [Portugal], S.A). MHRA. https://products.mhra.gov.uk. Accessed 04/05/2023.Dobutamine 5 mg/mL, Solution for Infusion (Hameln Pharma Ltd). MHRA. https://products.mhra.gov.uk. Accessed 04/05/2023.Dobutamine Hydrochloride in Dextrose Injection (Baxter Healthcare Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 04/05/2023.Dobutamine Injection, Solution Concentrate (Hainan Poly Pharm. Co., Ltd.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 04/05/2023.Dobutamine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 04/05/2023.Inotrop 25 mg/mL Concentrate for Solution for Infusion (Medispec [M] Sdn. Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 04/05/2023.Joint Formulary Committee. Dobutamine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 04/05/2023.Max Health Ltd. Dobutamine-Hameln 12.5 mg/mL Concentrate for Solution for Infusion data sheet 15 July 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 04/05/2023.Paediatric Formulary Committee. Dobutamine. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 04/05/2023.
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