Dobutamine
Mechanism :
Dobutamine is a direct-acting inotropic agent whose primary activity results from stimulation of the b-receptors of the heart while producing comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects. It does not cause the release of endogenous norepinephrine, as does dopamine.
Indication :
- Cardiac failure
- Cardiac surgery
- Septicemia
- Myocardial stress testing
Contraindications :
Dobutamine is contraindicated in patients with idiopathic hypertrophic subaortic stenosis and in patients who have shown previous manifestations of hypersensitivity to dobutamine.
Dosing :
Continuous IV infusion: 2-10 microgram/kg/min increased to a max of 20 microgram/kg/min in newborn and 40 microgram/kg/min in older children if necessary.
Suggested drip administration: 6 x wt (kg) x desired dose (mcg/kg/min)/desired fluid rate (Ml/hr) = mg of dobutamine per 100 ml solution.
Adverse Effect :
Chest pain, tachycardia, angina, ectopic beats, palpitation, hypertension, nausea, vomiting, tingling sensation, paraesthesia, dyspnea, headache, hypersensitivity (rash, fever, bronchospasm), hypokalemia.
Interaction :
Nitroprusside: Concomitant use of dobutamine and nitroprusside results in a higher cardiac output and, a lower pulmonary wedge pressure than when either drug is used alone.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Not dialysed. Dose as in normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended. Titrate the dobutamine infusion rate as per clinical response.