II. Mechanism

  1. Synthetic Catecholamine (Sympathomimetic amine) derived from Dopamine
  2. Overall effect similar to Dopamine with Nitroprusside
  3. Selective for Beta Adrenergic Receptors (primarily B1)
    1. Beta 1 Adrenergic Receptor (potent)
      1. Increased cardiac contractility, but minimal increase in Heart Rate
    2. Beta 2 Adrenergic Receptor (weak)
      1. Mild increase in vasodilation
      2. Does not directly affect renal or splanchnic flow
  4. Relatively mild Alpha 1 Adrenergic Receptor effect
    1. Vasoconstriction countered by more potent beta effect
    2. No significant impact on Peripheral Vascular Resistance
  5. No Dopaminergic Receptor activity (unlike Dopamine)
  6. Minimal effects on myocardial oxygen demand
    1. Favorable balance between oxygen supply and demand
      1. Preferred in Cardiogenic Shock over Dopamine
      2. Increased perfusion balances inotropic strain
      3. Benefit lost if not titrated to avoid Tachycardia
    2. Does not increase infarct size
    3. Does not elicit Arrhythmia

III. Pharmacokinetics

  1. Short Half-Life
    1. As with other Catecholamines, rapidly metabolized by COMT and MAO
    2. Only effective by infusion

IV. Indications

  1. Cardiogenic Shock (Severe Congestive Heart Failure)
    1. Pulmonary congestion or Hypotension
    2. Right ventricular infarction
      1. Use with fluid Resuscitation
    3. Often used in combination with Dopamine
      1. Moderate dosages of each (7.5 ug/kg/min)
      2. Maintains critical organ perfusion
      3. Less pulmonary congestion than with Dopamine alone
      4. Not shown to alter mortality
      5. May alter secondary organ injury outcomes
  2. Not usually indicated in non-Cardiogenic Shock
    1. Other Catecholamines preferred in other shock types
    2. In Septic Shock, may be useful in enhancing left ventricular function
      1. However, Norepinephrine is preferred agent in fluid refractory Septic Shock

V. Dosing: Pediatric Infusion (Same as Dopamine preparation)

  1. Preparation
    1. Draw up "x" mg of Dobutamine
    2. Where "x" = 6 x Weight in Kilograms
    3. Add enough D5W or NS to Dobutamine for 100 ml total
    4. At this dilution
      1. Infusion rate of 1 ml/h provides 1.0 ug/kg/min
  2. Start Dose: 5-10 ug/kg/min or 5-10 ml/hour
  3. Titrate to clinical response (usually <20 ug/kg/min)

VI. Dosing: Adult Infusion

  1. Preparation
    1. Start with 2-4 ampules Dobutamine (250 mg each)
    2. Dissolve 500-1000 mg Dobutamine in 250 ml D5W or NS
    3. Final Concentration: 2000-4000 ug/ml
  2. Start Dose: 0.5 to 2.0 ug/kg/min
  3. Titrate: 2-20 ug/kg/min to clinical response
    1. Perfusion
    2. Urine Output
    3. Blood Pressure
    4. Avoid increasing Heart Rate 10% over baseline

VII. Adverse Effects

VIII. References

  1. Olson (2020) Clinical Pharmacology, Medmasters, Miami, p. 13-33
  2. Goldstein (2010) Clin Auton Res 20(6):331-52 +PMID: 20623313 [PubMed]

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