Yes

Adrenergic Agonist Agent

Adjunct in the treatment of shock (eg, MI, open heart surgery, renal failure, cardiac decompensation, etc) which persists after adequate fluid volume replacement

C

Hypersensitivity to sulfites (commercial preparation contains sodium bisulfite); pheochromocytoma; ventricular fibrillation

Use with caution in patients with cardiovascular disease or cardiac arrhythmias or patients with occlusive vascular disease. Correct hypovolemia and electrolytes when used in hemodynamic support. May cause increases in HR and arrhythmia. Avoid infiltration - may cause severe tissue necrosis. Use with caution in post-MI patients.

Incidence of adverse events is not reported.

Cardiovascular: Ectopic beats, tachycardia, anginal pain, palpitations, hypotension, vasoconstriction

Central nervous system: Headache

Gastrointestinal: Nausea and vomiting

Respiratory: Dyspnea

Infrequent: Aberrant conduction, bradycardia, piloerection, widened QRS complex, azotemia, elevated pressure, polyuria, dilated pupils, ventricular arrhythmias (high dose), gangrene (high dose), hypertension, azotemia, anxiety, elevations in serum glucose (usually not above normal limits); extravasation of dopamine can cause tissue necrosis and sloughing of surrounding tissues.

Symptoms of overdose include severe hypertension, cardiac arrhythmias, acute renal failure

Important: Antidote for peripheral ischemia: To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible with 10-15 mL of saline solution containing from 5-10 mg of Regitine® (brand of phentolamine), an adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, and the solution liberally infiltrated throughout the ischemic area. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. Therefore, phentolamine should be given as soon as possible after the extravasation is noted.

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

Cocaine may cause malignant arrhythmias; avoid concurrent use.

Guanethidine's hypotensive effects may only be partially reversed; may need to use a direct-acting sympathomimetic.

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.

Protect from light; solutions that are darker than slightly yellow should not be used; incompatible with alkaline solutions or iron salts; compatible when coadministered with dobutamine, epinephrine, isoproterenol, and lidocaine

Stimulates both adrenergic and dopaminergic receptors, lower doses are mainly dopaminergic stimulating and produce renal and mesenteric vasodilation, higher doses also are both dopaminergic and beta₁-adrenergic stimulating and produce cardiac stimulation and renal vasodilation; large doses stimulate alpha-adrenergic receptors

Children: With medication changes, may not achieve steady-state for ~1 hour rather than 20 minutes

Adults: Onset of action: 5 minutes; Duration: <10 minutes

Metabolism: In the plasma, kidneys, and liver 75% to inactive metabolites by monoamine oxidase and 25% to norepinephrine (active)

Half-life: 2 minutes

Elimination: Metabolites are excreted in urine; neonatal clearance varies and appears to be age related; clearance is more prolonged with combined hepatic and renal dysfunction

Dopamine has exhibited nonlinear kinetics in children

I.V. infusion (administration requires the use of an infusion pump):

Children: 1-20 mcg/kg/minute, maximum: 50 mcg/kg/minute continuous infusion, titrate to desired response.

Adults: 1-5 mcg/kg/minute up to 50 mcg/kg/minute, titrate to desired response. Infusion may be increased by 1-4 mcg/kg/minute at 10- to 30-minute intervals until optimal response is obtained.

If dosages >20-30 mcg/kg/minute are needed, a more direct-acting pressor may be more beneficial (ie, epinephrine, norepinephrine).

The hemodynamic effects of dopamine are dose-dependent:

Low-dose: 1-3 mcg/kg/minute, increased renal blood flow and urine output

Intermediate-dose: 3-10 mcg/kg/minute, increased renal blood flow, heart rate, cardiac contractility, and cardiac output

High-dose: >10 mcg/kg/minute, alpha-adrenergic effects begin to predominate, vasoconstriction, increased blood pressure

Blood pressure, EKG, heart rate, CVP, RAP, MAP, urine output; if pulmonary artery catheter is in place, monitor Cl, PCWP, SVR, and PVR

Dopamine is most frequently used for treatment of hypotension because of its peripheral vasoconstrictor action. In this regard, dopamine is often used together with dobutamine and minimizes hypotension secondary to dobutamine-induced vasodilation. Thus, pressure is maintained by increased cardiac output (from dobutamine) and vasoconstriction (by dopamine). It is critical neither dopamine nor dobutamine be used in patients in the absence of correcting any hypovolemia as a cause of hypotension.

None noted

Dopamine's effects may be enhanced by MAO inhibitors

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.

Extravasation: Due to short half-life, withdrawal of drug is often only necessary treatment. Use phentolamine as antidote; mix 5 mg with 9 mL of NS; inject a small amount of this dilution into extravasated area; blanching should reverse immediately. Monitor site; if blanching should recur, additional injections of phentolamine may be needed.

Infusion, as hydrochloride, in D₅W: 0.8 mg/mL (250 mL, 500 mL); 1.6 mg/mL (250 mL, 500 mL); 3.2 mg/mL (250 mL, 500 mL)

Injection, as hydrochloride: 40 mg/mL (5 mL, 10 mL, 20 mL); 80 mg/mL (5 mL, 20 mL); 160 mg/mL (5 mL)

Banner W, Jr, Vernon DD, Dean JM, et al, "Nonlinear Dopamine Pharmacokinetics in Pediatric Patients," J Pharmacol Exp Ther, 1989, 249(1):131-3.

Chan TY, "Low-Dose Dopamine in Severe Right Heart Failure and Chronic Obstructive Pulmonary Disease," Ann Pharmacother, 1995, 29(5):493-6.

Martin C, Papazian L, Perrin G, et al, "Norepinephrine or Dopamine for the Treatment of Hyperdynamic Septic Shock?" Chest, 1993, 103(6):1826-31.

Strauss R, "Accidental Dopamine in the Eye," West J Med, 1985, 142(3):397-8.