No

Adrenergic Agonist Agent

Short-term management of patients with cardiac decompensation

B (note Pregnancy comments)

Hypersensitivity to dobutamine or sulfites (some contain sodium metabisulfate); idiopathic hypertrophic subaortic stenosis (IHSS)

Can see an increase in heart rate. Patients with atrial fibrillation may experience an increase in ventricular response. An increase in blood pressure is more common, but occasionally a patient may become hypotensive. May exacerbate ventricular ectopy. If needed, correct hypovolemia first to optimize hemodynamics. Ineffective in the presence of mechanical obstruction such as severe aortic stenosis. Use caution post-MI (can increase myocardial oxygen demand). Use cautiously in the elderly starting at lower end of the dosage range.

Incidence of adverse events is not always reported.

Central nervous system: Fever (1% to 3%), headache (1% to 3%), paresthesia

Endocrine & metabolic: Slight decrease in serum potassium

Gastrointestinal: Nausea (1% to 3%)

Hematologic: Thrombocytopenia (isolated cases)

Local: Phlebitis, local inflammatory changes and pain from infiltration, cutaneous necrosis (isolated cases)

Neuromuscular & skeletal: Mild leg cramps

Respiratory: Shortness of breath (1% to 3%)

Symptoms of overdose include fatigue, nervousness, tachycardia, hypertension, arrhythmias

Reduce rate of administration or discontinue infusion until condition stabilizes

Beta-blockers (nonselective ones) may increase hypertensive effect; avoid concurrent use.

Cocaine may cause malignant arrhythmias; avoid concurrent use.

Guanethidine can increase the pressor response; be aware of the patient's drug regimen.

MAO inhibitors potentiate hypertension and hypertensive crisis; avoid concurrent use.

Methyldopa can increase the pressor response; be aware of patient's drug regimen.

Reserpine increases the pressor response; be aware of patient's drug regimen.

TCAs increase the pressor response; be aware of patient's drug regimen.

Remix solution every 24 hours; store reconstituted solution under refrigeration for 48 hours or 6 hours at room temperature; pink discoloration of solution indicates slight oxidation but no significant loss of potency.

Standard adult diluent: 250 mg/500 mL D₅W; 500 mg/500 mL D₅W

Incompatible with heparin, cefazolin, penicillin, and sodium bicarbonate; incompatible in alkaline solutions (sodium bicarbonate)

Compatible with dopamine, epinephrine, isoproterenol, lidocaine

Stimulates beta₁-adrenergic receptors, causing increased contractility and heart rate, with little effect on beta₂- or alpha-receptors

Onset of action: I.V.: 1-10 minutes

Peak effect: Within 10-20 minutes

Metabolism: In tissues and the liver to inactive metabolites

Half-life: 2 minutes

Elimination: Metabolites are excreted in urine

Administration requires the use of an infusion pump; I.V. infusion. See guidelines below:

Using 250 mg/500 mL diluent (500 mcg/mL); infuse at 0.005 mL/kg/minute

Using 500 mg/500mL diluent (1mg/mL); infuse at 0.0025 mL/kg/minute

To deliver 5 mcg/kg/minute:

Using 250 mg/500 mL diluent (500 mcg/mL); infuse at 0.01 mL/kg/minute

Using 500 mg/500 mL diluent (1 mg/mL); infuse at 0.005 mL/kg/minute

To deliver 7.5 mcg/kg/minute:

Using 250 mg/500 mL diluent (500 mcg/mL); infuse at 0.015 mL/kg/minute

Using 500 mg/500 mL diluent (1 mg/mL); infuse at 0.0075 mL/kg/minute

To deliver 10 mcg/kg/minute:

Using 250 mg/500 mL diluent (500 mcg/mL); infuse at 0.02 mL/kg/minute

Using 500 mg/500 mL diluent (1 mg/mL); infuse at 0.01 mL/kg/minute

To deliver 12.5 mcg/kg/minute:

Using 250 mg/500 mL diluent (500 mcg/mL); infuse at 0.025 mL/kg/minute

Using 500 mg/500 mL diluent (1 mg/mL); infuse at 0.0125 mL/kg/minute

To deliver 15 mcg/kg/minute:

Using 250 mg/500 mL diluent (500 mcg/mL); infuse at 0.03 mL/kg/minute

Using 500 mg/500 mL diluent (1 mg/mL); infuse at 0.015 mL/kg/minute

To deliver 20 mcg/kg/minute:

Using 250 mg/500 mL diluent (500 mcg/mL); infuse at 0.04 mL/kg/minute

Using 500 mg/500 mL diluent (1 mg/mL); infuse at 0.02 mL/kg/minute

Neonates: 2-15 mcg/kg/minute, titrate to desired response

Children and Adults: 2.5-20 mcg/kg/minute; maximum: 40 mcg/kg/minute, titrate to desired response

Blood pressure, EKG, heart rate, CVP, RAP, MAP, urine output; if pulmonary artery catheter is in place, monitor CI, PCWP, and SVR; also monitor serum potassium

Dobutamine therapy should be avoided in patients with stable heart failure due to an increase in mortality. In patients with intractable heart failure, dobutamine may be used as a short-term infusion to provide symptomatic benefit. It is not known whether short-term dobutamine therapy in end-stage heart failure has any outcome benefit.

None noted

None noted

No information available to require special precautions

No effects or complications reported

When administered in emergencies, patient education should be appropriate to the situation. If patient is aware, instruct to promptly report chest pain, palpitations, rapid heartbeat, headache, nervousness, or restlessness, nausea or vomiting, or difficulty breathing. Breast-feeding precautions: Consult prescriber if breast-feeding.

Management of extravasation: Phentolamine: Mix 5 mg with 9 mL of NS; inject a small amount of this dilution into extravasation area; blanching should reverse immediately. Monitor site; if blanching should recur, additional injections of phentolamine may be needed.

Infusion, as hydrochloride: 12.5 mg/mL (20 mL)

Leier CV, Webel J, and Bush CA, "The Cardiovascular Effects of the Continuous Infusion of Dobutamine in Patients With Severe Cardiac Failure," Circulation, 1977, 56:468-78.

Paulman PM, Cantral K, Meade JG, et al, "Dobutamine Overdose," JAMA, 1990, 264(18):2386-7.

Rich MN, Woods WL, Davila-Roman VG, et al, "A Randomized Comparison of Intravenous Amrinone Versus Dobutamine in Older Patients With Decompensated Congestive Heart Failure," J Am Geriatr Soc, 1995, 43(3):271-4.

Wirtz CE, "Sustained Atrial Fibrillation After Dobutamine Stress Echocardiography in an Older Patient With Left Atrial Enlargement," West J Med, 1995, 162(3):268-9.