Dobutamine

• Dobutamine

• Dobutrex

Classification:

• Sympathomimetic

Mechanism of Action:

• Stimulates the β1 receptors in the heart resulting in increased cardiac output
• Increases contractility without inducing marked tachycardia (positive Inotrope)
• Increases stroke volume
• Some increase in heart rate (positive Chronotrope)
• Decreased systemic vascular resistance
• Reduces ventricular filling pressure

Indications:

• Decreased heart function due to cardiac contractility
• Systolic BP 70 – 100 mmHg with no signs of shock
  

Contraindications:

• Untreated hypovolemia
• Vasodilatory shock (septic, neurogenic, anaphylactic).  Dobutamine can cause further vasodilatation and worsen hypotension in these patients

Precautions:

• Monitor EKG
• Monitor BP at least every 2-5min while initiating and titrating
• Use caution in patients with tachycardia or ventricular ectopy, as dobutamine potentiates both, but less than dopamine does
• Patients should be adequately hydrated
• Beta blockers may antagonize dobutamine effects.  Do not use together
• Don’t use with Sodium Bicarbonate (will deactivate the medication)
• Allergic cross reaction in those with sulfite allergies

Adverse Effects:

• May increase myocardial ischemia
• Headache
• Hypertension
• Palpitations

Dose:

Adult:

• Start 2.5 - 5 mcg/kg/min IV; titrate for SBP > 90 up to 20 mcg/kg/min.  For BP < 90 may need to start with dopamine then add dobutamine, or if BP drops initially add dopamine

Pediatric:

• Start at 5 mcg/kg/min IV

• IV

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Professional 2^nd Edition