Classifications: beta-adrenergic agonist; catecholamine; Therapeutic: cardiac stimulant
Pregnancy Category: C
12.5 mg/mL injection
Produces inotropic effect by acting on beta receptors and primarily on myocardial alpha-adrenergic receptors. Increases
cardiac output and decreases pulmonary wedge pressure and total systemic vascular resistance with comparatively little or
no effect on BP. Also increases conduction through AV node, and has lower potential for precipitating arrhythmias than dopamine.
In CHF or cardiogenic shock it increases cardiac output, enhances renal perfusion, increases renal output, and renal sodium
Inotropic support in short-term treatment of adults with cardiac decompensation due to depressed myocardial contractility
(cardiogenic shock) resulting from either organic heart disease or from cardiac surgery.
To augment cardiovascular function in children undergoing cardiac catheterization, stress thallium testing.
History of hypersensitivity to other sympathomimetic amines or sulfites, ventricular tachycardia, idiopathic hypertrophic
subaortic stenosis; hypovolemia; pregnancy (category C); children <2 y.
Preexisting hypertension, hypotension; atrial fibrillation; acute MI; unstable angina, severe coronary artery disease.
Route & Dosage
Adult: IV 0.51 mcg/kg/min then titrate up to 2.515 mcg/kg/min (max: 40 mcg/kg/min)
Adolescent/Child: IV 220 mcg/kg/min
PREPARE: Continuous: ??Reconstitute by adding 10 mL sterile water for injection or D5W to 250-mg vial; if not completely dissolved, add an additional
10 mL of diluent.??Further dilution is typical (e.g., 250 mg in 1000 mL yields 250 mcg/mL; 250 mg in 500 mL yields 500 mcg/mL; 250 mg in 250
mL yields 1000 mcg/mL).??Use IV solutions within 24 h.
ADMINISTER: Continuous: ??Rate of infusion is determined by body weight and controlled by an infusion pump (preferred) or a microdrip IV infusion
set.??IV infusion rate and duration of therapy are determined by heart rate, blood pressure, ectopic activity, urine output, and
whenever possible, by measurements of cardiac output and central venous or pulmonary wedge pressures.
INCOMPATIBILITIES Solution/additive: Acyclovir, alteplase, aminophylline, bretylium, bumetanide, calcium chloride, calcium gluconate, diazepam, digoxin, furosemide, heparin, insulin, magnesium sulfate, phenytoin, potassium chloride, potassium phosphate, sodium bicarbonate. Y-site: Acyclovir, alteplase, aminophylline, amphotericin B cholesteryl sulfate, cefepime, foscarnet, furosemide, heparin, indomethacin, lansoprazole, pantoprazole, pemetrexed, phytonadione, piperacillin/tazobactam, thiopental, warfarin.
- Refrigerate reconstituted solution at 2°15° C (36°59° F) for 48 h or store for 6 h at room
Adverse Effects (≥1%)All:
Generally dose related. CNS:
Headache, tremors, paresthesias, mild leg cramps, nervousness, fatigue
(with overdosage). CV: Increased heart rate and BP,
premature ventricular beats, palpitation, anginal pain. GI:
Nausea, vomiting. Other:
Nonspecific chest pain, shortness of breath.
InteractionsDrug: general anesthetics
) may sensitize myocardium to effects of catecholamines
such as dobutamine and lead to serious arrhythmiasuse with extreme caution; beta-adrenergic blocking agents
(e.g., metoprolol, propranolol
) may make dobutamine ineffective in increasing cardiac output, but total peripheral resistance may increaseconcomitant
use generally avoided; mao inhibitors
, tricyclic antidepressants
potentiate pressor effectsuse with extreme caution.
210 min. Peak:
1020 min. Metabolism:
Metabolized in liver and other tissues by COMT. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Correct hypovolemia by administration of appropriate volume expanders prior to initiation of therapy.
- Monitor therapeutic effectiveness. At any given dosage level, drug takes 1020 min to produce peak effects.
- Monitor ECG and BP continuously during administration.
- Note: Marked increases in blood pressure (systolic pressure is the most likely to be affected) and heart rate, or the appearance
of arrhythmias or other adverse cardiac effects are usually reversed promptly by reduction in dosage.
- Observe patients with preexisting hypertension closely for exaggerated pressor response.
- Note: Tolerance has been observed with continuous or prolonged infusions; adverse reactions are no different than those seen with
- Monitor I&O ratio and pattern. Urine output and sodium excretion generally increase because of improved cardiac output and
Patient & Family Education
- Report anginal pain to physician promptly.