Dobutamine

Aka: Dobutamine, Dobutrex

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II. Indications

  1. Cardiogenic Shock (Severe Congestive Heart Failure)
    1. Consider in combination with agents that reduce Afterload
    2. Pulmonary congestion or Hypotension
    3. Right ventricular infarction
      1. Use with fluid Resuscitation
    4. 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

III. Contraindications

  1. Hypertrophic Subaortic Stenosis

IV. 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 perfusion
  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

V. Precautions

  1. Avoid infusions >48 hours
  2. Closely monitor vitals signs (esp. BP, Heart Rate) and telemetry during Dobutamine infusion

VI. Dosing: Adult Infusion

  1. Standard Concentration Preparation
    1. Start with 250 mg Dobutamine (1 ampule)
    2. Dissolve in 250 ml D5W
    3. Final Concentration: 1 mg/ml
      1. Rate 4.2 ml/hour infuses 1 mcg/kg/min for a 70 kg patient
  2. High Concentration Preparation (caution!)
    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 mcg/ml
  3. Start Dose: 0.5 to 1.0 mcg/kg/min
  4. Titrate: 2-20 mcg/kg/min to clinical response
    1. Perfusion
    2. Urine Output
    3. Blood Pressure
    4. Avoid increasing Heart Rate 10% over baseline

VII. PDosing: 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 mcg/kg/min
  2. Start Dose: 5 to 10 mcg/kg/min or 5-10 ml/hour
  3. Titrate to clinical response (usually <20 ug/kg/min)

VIII. harmacokinetics

  1. Half-Life: 2-3 minutes
    1. As with other Catecholamines, rapidly metabolized by COMT and MAO
    2. Only effective by infusion

IX. Adverse Effects

  1. Tachycardia
  2. Ventricular Arrhythmia
  3. Ectopic beats
  4. Provokes Myocardial Ischemia if Tachycardia occurs
  5. Headache
  6. Nausea
  7. Tremor
  8. Hypokalemia
  9. Hypotension
  10. Dyspnea

X. Resources

  1. Dobutamine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=dc537761-d5f4-488d-24ab-b2bcd2b17b7a

XI. 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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Related Studies

Ontology: Dobutamine (C0012963)

Definition (MSH) A catecholamine derivative with specificity for BETA-1 ADRENERGIC RECEPTORS. It is commonly used as a cardiotonic agent after CARDIAC SURGERY and during DOBUTAMINE STRESS ECHOCARDIOGRAPHY.
Definition (NCI) A synthetic catecholamine with sympathomimetic activity. Dobutamine is a direct-acting inotropic agent and an adrenergic agonist that stimulates primarily the beta-1 adrenoceptor, with lesser effect on beta-2 or alpha receptors. Via beta-1 adrenoceptor of the heart, this agent induces positive inotropic effect with minimal changes in chronotropic activities or systemic vascular resistance. Dobutamine also causes vasodilation by stimulating beta-2 adrenergic receptors in blood vessels, augmented by reflex vasoconstriction resulting in increased cardiac output.
Definition (CSP) beta-2 agonist catecholamine that has cardiac stimulant action without evoking vasoconstriction or tachycardia; it is proposed as a cardiotonic after myocardial infarction or open heart surgery.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004280
SnomedCT 26523005, 387145002
LNC LP35685-4, LP19573-2, MTHU008963
English Dobutamine, 1,2-Benzenediol, 4-(2-((3-(4-hydroxyphenyl)-1-methylpropyl)amino)ethyl)-, (+-)-, Dobutamine [Chemical/Ingredient], DOBUTamine, dobutamine, DOBUTAMINE, Dobutamine (product), Dobutamine (substance)
Swedish Dobutamin
Czech dobutamin
Finnish Dobutamiini
Russian DOBUTAMIN, ДОБУТАМИН
Japanese ドブタミン
Croatian DOBUTAMIN
Polish Dobutamina
Spanish dobutamina (producto), dobutamina (sustancia), dobutamina, Dobutamina
French Dobutamine
German Dobutamin
Italian Dobutamina
Portuguese Dobutamina
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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