II. Mechanism
- Synthetic Sympathomimetic amine
- Overall effect similar to Dopamine with Nitroprusside
- Selective for Beta Adrenergic Receptors
- Beta 1 Adrenergic Receptor
- Increased cardiac contractility and Heart Rate
- Beta 2 Adrenergic Receptor
- Mild increase in vasodilation
- Does not directly affect renal or splanchnic flow
- Beta 1 Adrenergic Receptor
- Relatively mild Alpha 1 Adrenergic Receptor effect
- Vasoconstriction countered by more potent beta effect
- Minimal effects on myocardial oxygen demand
- Favorable balance between oxygen supply and demand
- Preferred in Cardiogenic Shock over Dopamine
- Increased perfusion balances inotropic strain
- Benefit lost if not titrated to avoid Tachycardia
- Does not increase infarct size
- Does not elicit arrhythmia
- Favorable balance between oxygen supply and demand
III. Pharmacokinetics
- Short half-life
- Only effective by infusion
IV. Indications
-
Cardiogenic Shock (Severe Congestive Heart Failure)
- Pulmonary congestion or Hypotension
- Right ventricular infarction
- Use with fluid Resuscitation
- Often used in combination with Dopamine
- Moderate dosages of each (7.5 ug/kg/min)
- Maintains critical organ perfusion
- Less pulmonary congestion than with Dopamine alone
- Not shown to alter mortality
- May alter secondary organ injury outcomes
-
Septic Shock
- May be useful in enhancing left ventricular function
- Epinephrine is preferred agent in Septic Shock
- Not usually indicated in non-Cardiogenic Shock
- Other Catecholamines preferred in other shock types
V. Pediatric Infusion (Same as Dopamine preparation)
- Preparation
- Draw up "x" mg of Dobutamine
- Where "x" = 6 x Weight in Kilograms
- Add enough D5W or NS to Dobutamine for 100 ml total
- At this dilution
- Infusion rate of 1 ml/h provides 1.0 ug/kg/min
- Start Dose: 5-10 ug/kg/min or 5-10 ml/hour
- Titrate to clinical response (usually <20 ug/kg/min)
VI. Adult Infusion
- Preparation
- Start with 2-4 ampules Dobutamine (250 mg each)
- Dissolve 500-1000 mg Dobutamine in 250 ml D5W or NS
- Final Concentration: 2000-4000 ug/ml
- Start Dose: 0.5 to 2.0 ug/kg/min
- Titrate: 2-20 ug/kg/min to clinical response
- Perfusion
- Urine output
- Blood Pressure
- Avoid increasing Heart Rate 10% over baseline
VII. Adverse Effects
- Tachycardia
- Arrhythmia
- Ectopic beats
- Provokes Myocardial Ischemia if Tachycardia occurs
- Headache
- Nausea
- Tremor
- Hypokalemia
Images: Related links to external sites (from Bing)
Related Studies (from Trip Database) Open in New Window
| 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 |
