Dopamine Hydrochloride

dr.joan

Dopamine Hydrochloride:
Trade names: Intropin, docard
Class: Direct & indirect acting adrenergic agent.
N.B.: Available for hospital use only on 5 ml ampoules containing 200 mg Doparninc hydrochloride.
Pregnancy: (Category C)

Action:
It is the immediate precursor of epinephrine in the body.
It produces direct stimulation of β1 receptors resulting in increasing myocardial contraction, cardiac output as well as increase renal blood flow & sodium excretion.
It exerts little effect on diastolic B.P. & induce fewer arrhythrrias that seen on other adrenergic.
Alpha receptors, which are stimulated by higher doses of dopamine exerts vasodilatation effects which can override the vasodilating effect.
In higher doses it stimulates alpha receptors leading to peripheral vasoconstriction.
Indications:
§ Cardiogenic shocks especially in M.I. associated with sever C.H.F
§ Hypotension due to poor cardiac out put.
§ Shock associated with septicemia, trauma, heart surgery, renal failure & C.H.F.
§ Cardiomyopathy.
§ In lower doses (1-5 Mcg/kg/min) used in renal failure.
Contraindications:
§ Pheochromocytoma, uncorrected tachycardia, arrhythmias.
§ Hypovolemia.
§ Safety and efficacy is not established in children.
Side effects:
§ GI: Nausea and vomiting.
§ CV: Ectopic heart-beats, tachycardia or bradycardia, anginal pain, palpitation, hypotension or hypertension, dyspnea, wide QRS complex.
§ Others: headache.
Dosage and administration:
N.B.: This is a potent drug.
It must be diluted before administration to the patient.
Suggested dilution:
Transfer contents of one ampoule (5ml containing 200 mg of dopamine) by aseptic technique to either 250 or 500 ml bottle of sterile I.V. solution (saline, dextrose 5% or ringer lactate). These dilutions will yield a final concentration for administration as follows.
- 250 ml dilution contains 800 mcg\ml of dopamine.
- 500 ml dilution contains 400 mcg\ml of dopamine.
N.B.:
1- Solution stable after dilution for 24 hours.
2- Don’t add dopamine to NaHCO3 or other alkaline I.V. solutions since the drug is inactivated in alkaline solution.
Rate of administration.
Through a suitable I.V. needle or a catheter & through an electronic infusion pump, rate is regulated according to required dose.
Dose:
Renal dose: 1-5 Mcg\kg\minute.
Cardiac dose: start initially of 5 Mcg/kg/min then increase by increments up to a rate of 20-50 Mcg/kg/min.
Nursing considerations:
§ Administer only by IV INFUSION (Not IV bolus nor IM)
§ Drug must be diluted before use.
§ Administer drug through a central line or a big vein (vein in the anticupital fossa is preferred over those in the hand).
§ Stop the drug by small increments.
§ Solution is stable for 24 hrs, protect it from light.
§ Monitor B.P. & ECG continuously during drug administration.
§ Monitor intake & out put.
§ Monitor patient for occurrence of side effects.
§ Check I.V. site for sighs of extravasations.

Drug should be administered through electronic infusion device.