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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