Pharm
Dopamine
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Dopamine
, Intropin, Dopamine Hydrochloride
Mechanism
Low dose (2-5 ug/kg/min)
Increases splanchnic flow
Increases coronary perfusion
Increases cerebral flow
Increases renal perfusion
Previously recommended for oliguric
Renal Failure
No longer recommended due to lack of GFR effect
Mid-dose (5-10 ug/kg/min)
Direct
Beta Adrenergic Receptor
effects
Increases cardiac contractility
No effect on
Blood Pressure
No effect on
Heart Rate
Stimulates
Norepinephrine
release
Effect blunted if
Norepinephrine
stores depleted
High Dose (10-20 ug/kg/min)
Increase in
Blood Pressure
Tachycardia
may be significant problem
Vasocon
striction of renal and splanchnic beds
Half life of Dopamine is short and requires infusion
Indications
Hemodynamically significant
Hypotension
Systolic
Blood Pressure
under 90 mmHg
Poor Tissue perfusion
Oliguria
or
Anuria
Altered Level of Consciousness
No
Hypovolemia
Hypotension
following
Resuscitation
Symptomatic Bradycardia
Return of Spontaneous Circulation
Contraindications
Absolute
Pheochromocytoma
Risk of
Hypertensive Crisis
Contraindications
Relative (or use low dose Dopamine)
Increased vascular resistance
Pulmonary congestion or
Congestive Heart Failure
Increased
Preload
Precautions
Dopamine has been largely replaced by
Norepinephrine
in adults in U.S.
Theoretically safer than
Norepinephrine
when used peripherally
However
Norepinephrine
is often initially used via a reliable peripheral IV safely
Theoretically with greater renal protection than other
Vasopressor
s
Does not appear to offer any significant benefit over other
Vasopressor
s in renal protection
In children, Dopamine is still a first-line
Vasopressor
despite risks
See the adverse effects (e.g.
Dysrhythmia
) below
Dopamine is asssociated with a three fold increased mortality in septic children
Ventura (2015) Crit Care Med 43(11): 2292-302 +PMID: 26323041 [PubMed]
Dosing
Pediatric Infusion (Same as
Dobutamine
preparation)
Preparation
Draw up "x" mg of Dopamine
Where "x" = 6 x Weight in Kilograms
Add enough D5W or NS to Dopamine for 100 ml total
At this dilution
Infusion rate of 1 ml/h provides 1.0 ug/kg/min
Start Dose: 10 ug/kg/min or 10 ml/hour
Titrate to effect
Perfusion
Urine Output
Blood Pressure
Dosing
Adult Infusion
Preparation
Start with 1-2 ampules Dopamine (400 mg each)
Dissolve 400-800 mg Dopamine in 250 ml D5W
Final Concentration: 1600-3200 ug/ml
Start Dose: 1-5 ug/kg/min
Titrate: 5-20 ug/kg/min to clinical response
Perfusion
Urine Output
Blood Pressure
Adverse Effects
Tachycardia
Increases myocardial oxygen demand
Arrhythmia
s
Premature Ventricular Contraction
(PVC)
Supraventricular Tachycardia
(SVT)
Ventricular Tachycardia
(VT)
Hypertensive Crisis
Increases Pulmonary artery wedge pressure
May worsen pulmonary congestion
May provoke
Congestive Heart Failure
Gastrointestinal
Nausea
and
Vomiting
Precautions
Avoid Dopamine dose over 20 ug/kg/min
Results in severe
Vasocon
striction and ischemia
Consider adding
Norepinephrine
if inadequate BP
Use caution with Dopamine in
Congestive Heart Failure
Consider adding Vasodilator
Nitroprusside
Nitroglycerin
Consider using
Dobutamine
instead of Dopamine
Taper Dopamine gradually to avoid
Hypotension
Use Dopamine via central venous catheter
Extravasation causes severe local tissue damage
Antidote for extravasation
Phentolamine 5-10 mg diluted in 10-15 ml NS
Infiltrate area of extravasation with Phentolamine
Drug Interactions
Sodium Bicarbonate
inactivates Dopamine
Also occurs with
Epinephrine
Monoamine Oxidase Inhibitor
s potentiate Dopamine effect
Use only one tenth of regular dose
Bretylium
effects may be synergistic with Dopamine
Phenytoin
may cause
Hypotension
with Dopamine
References
Goldberg (2015) Crit Dec Emerg Med 29(3): 9-19
McCollum in Herbert (2019) EM:Rap 19(7):4-6
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