Adult: For the correction of haemodynamic imbalances due to MI, trauma, endotoxic septicaemia, renal failure, open-heart surgery, and chronic cardiac decompensation in CHF: Initially, 2-5 mcg/kg/min via continuous IV infusion using an infusion pump, increased gradually in increments of 5-10 mcg/kg/min according to the patient's haemodynamic and renal response (as indicated by blood pressure, heart rate, cardiac output, urine flow, central venous or pulmonary wedge pressure). For more severe cases: Initially, 5 mcg/kg/min via continuous IV infusion using an infusion pump, increased gradually in 5-10 mcg/kg/min increments up to 20-50 mcg/kg/min as needed. If doses exceeding 50 mcg/kg/min are required, frequently monitor the urine output. Dosage recommendations may vary among countries or local guidelines (refer to institution-specific treatment protocols). Child: For haemodynamic support: 2-20 mcg/kg/min via continuous IV infusion using an infusion pump; titrate the dose gradually by 5-10 mcg/kg/min increments until optimal response is achieved. Dosage recommendations may vary among countries or local guidelines (refer to institution-specific treatment protocols).
Special Patient Group
Patients currently taking MAOIs or who have been treated with MAOIs within the last 2-3 weeks before the administration of dopamine: Reduce the dopamine initial dose to one-tenth (1/10) of the usual dose.
Reconstitution
Concentrated solution for IV infusion: Adults: Dilute with the appropriate volume of dextrose 5% in water or other compatible IV solutions (e.g. NaCl 0.9% inj, dextrose 5% and NaCl 0.45% inj, Na lactate IV infusion, Lactated Ringer's solution) to a usual concentration of 1,600 mcg/mL or 3,200 mcg/mL. Children: Dilute with compatible IV fluids (e.g. dextrose 5% in water, NaCl 0.9% inj, dextrose 5% and NaCl 0.45% inj, Lactated Ringer's solution) to a Max concentration of 3,200 mcg/mL. Neonates: Dilute with compatible IV solutions (e.g. dextrose 5% in water, NaCl 0.9% inj, Lactated Ringer's solution) to a standard concentration of 1,600 mcg/mL. Recommendations for dilution and concentrations may vary among individual products and countries (refer to specific product guidelines).
Incompatibility
Incompatible with alkaline solutions (e.g. Na bicarbonate), furosemide, insulin, alteplase, thiopental Na, ampicillin, amphotericin B, and Fe salts.
Contraindications
Phaeochromocytoma, hyperthyroidism, uncorrected atrial/ventricular tachyarrhythmias or ventricular fibrillation. Concomitant use with cyclopropane and halogenated hydrocarbon anaesthetics.
Special Precautions
Patient with CV disease, cardiac arrhythmia, history of occlusive vascular disease (e.g. atherosclerosis, Raynaud's disease, cold injury, arterial embolism, diabetic endarteritis, Buerger's disease); active myocardial ischaemia or recent MI. Patients currently taking or who have been treated with MAOIs. Avoid extravasation; if possible, infuse into a large vein to reduce the risk of tissue necrosis. Avoid abrupt discontinuation. Renal and hepatic impairment. Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Decreased pulse pressure, hypotension; necrosis and sloughing of surrounding tissue (due to extravasation). Cardiac disorders: Anginal pain, ectopic heartbeats, tachycardia, palpitation, bradycardia, cardiac conduction abnormalities. Eye disorders: Mydriasis. Gastrointestinal disorders: Nausea, vomiting. Investigations: Widened QRS complex. Nervous system disorders: Headache. Psychiatric disorders: Anxiety. Renal and urinary disorders: Azotaemia. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Piloerection. Vascular disorders: Hypertension, vasoconstriction. Potentially Fatal: Gangrene of the extremities (particularly with high doses for prolonged periods or low doses in patients with occlusive vascular disease). Rarely, ventricular arrhythmias.
Correct hypovolaemia, electrolyte disturbances (particularly hypokalaemia and hypomagnesaemia), hypoxia, hypercapnia, and acidosis before treatment initiation. Closely monitor blood pressure, heart rate, ECG, cardiac output, pulmonary wedge pressure, central venous pressure, end-organ perfusion (e.g. urine output, mental status), intravascular volume status, and infusion site (for extravasation or peripheral ischaemia).
Overdosage
Symptoms: Excessive blood pressure elevation and vasoconstriction. Management: Reduce the rate of infusion or discontinue infusion until the condition of the patient stabilises. If these measures fail, consider the administration of an α-adrenergic blocker (e.g. phentolamine). Infiltrate the affected area as soon as possible with 10-15 mL of NaCl 0.9% inj containing 5-10 mg phentolamine to reverse ischaemia due to local vasoconstriction.
Drug Interactions
α-adrenergic receptor blockers antagonise the peripheral vasoconstriction caused by high dopamine doses. Cardiac effects of dopamine are antagonised by β-adrenergic blocking agents (e.g. metoprolol, propranolol). Potentiated effect and prolonged duration of action with MAOIs (e.g. isocarboxazid, phenelzine). May result in hypotension and bradycardia when given with phenytoin. May increase the effect of diuretics. May increase the risk of excessive vasoconstriction with ergot alkaloids. May lead to severe hypertension with some oxytocic agents. TCAs and guanethidine may potentiate the pressor response to dopamine. Haloperidol and haloperidol-like agents may suppress the dopaminergic renal and mesenteric vasodilation induced at low rates of dopamine infusion. Potentially Fatal: Cyclopropane or halogenated hydrocarbon anaesthetics (e.g. halothane, enflurane) elevate cardiac autonomic irritability and sensitise the myocardium to the effects of dopamine which may result in ventricular arrhythmia and hypertension.
Lab Interference
May suppress the pituitary secretion of TSH, growth hormone and prolactin.
Action
Description: Mechanism of Action: Dopamine, a precursor to norepinephrine, is a sympathomimetic agent that stimulates both dopaminergic and adrenergic receptors. It mainly has a direct effect on β1-adrenergic receptors; however, it also appears to have an indirect effect by releasing norepinephrine from storage sites in sympathetic nerve endings. Dopamine exerts dopaminergic effects at low doses, both dopaminergic and β1-adrenergic activity at moderate doses, and α-adrenergic effects at high doses. Onset: Within 5 minutes. Duration: <10 minutes. Pharmacokinetics: Distribution: Widely distributed in the body; however, it does not cross the blood-brain barrier to a significant extent. Metabolism: Metabolised in the liver, kidneys, and plasma by monoamine oxidase and COMT to the inactive compounds, homovanillic acid and 3,4-dihydroxyphenylacetic acid. Approx 25% is hydroxylated within the adrenergic nerve terminal to form norepinephrine (active). Excretion: Via urine (mainly as metabolites). Elimination half-life: Approx 2 minutes.
Chemical Structure
Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 681, Dopamine. https://pubchem.ncbi.nlm.nih.gov/compound/Dopamine. Accessed Aug. 16, 2023.
Storage
Intact ampoule/vial: Store below 30°C. Protect from light. Diluted solution: May be stored below 30°C or between 2-8°C for up to 24 hours. Premixed infusion solution in dextrose 5% inj: Store between 20-25°C. Do not freeze. Storage and stability recommendations may vary among individual products and countries (refer to specific product guidelines).
C01CA04 - dopamine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
References
Anon. Dopamine (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/06/2023.Anon. Dopamine. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 07/06/2023.Anon. Dopamine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/06/2023.Buckingham R (ed). Dopamine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/06/2023.Dopamine 40 mg/mL Sterile Concentrate (Hospira UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 07/06/2023.Dopamine Hydrochloride in Dextrose Injection, Solution (Hospira, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 07/06/2023.Dopamine Hydrochloride Injection (Hikma Pharmaceuticals, USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 07/06/2023.Dopamine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 07/06/2023.Joint Formulary Committee. Dopamine Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/06/2023.Max Health Ltd. Sterile Dopamine Concentrate BP 200 mg/5 mL, Injection for Solution data sheet 22 March 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 07/06/2023.Paediatric Formulary Committee. Dopamine Hydrochloride. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 07/06/2023.Pharmaniaga Dopamine Hydrochloride 40 mg/mL Injection (Pharmaniaga LifeScience Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 07/06/2023.
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