Dobutamine

Intravenous
Inotropic support
Adult: As short-term treatment of patients with cardiac decompensation due to depressed contractility resulting from decompensated heart failure, cardiogenic or septic shock, cardiomyopathies and cardiac surgeries: Usual dose range: 2.5-10 mcg/kg/min via continuous IV infusion using an infusion device; adjusted according to individual response (as measured by blood pressure, heart rate, cardiac and urine output, central venous and pulmonary capillary wedge pressure). Doses as low as 0.5 mcg/kg/min up to 40 mcg/kg/min may be required in some cases. Recommendations may vary among individual products and countries (refer to local detailed guidelines).
Child: Infants and children Initially, 0.5-1 mcg/kg/min given via continuous IV infusion using an infusion device, titrated gradually every few minutes to a usual dose range of 2-20 mcg/kg/min according to individual response. Alternatively, an initial dose of 5 mcg/kg/min via continuous IV infusion may be used, then adjusted to 2-20 mcg/kg/min based on clinical response. Doses are diluted up to a Max concentration of 5,000 mcg/mL. Administration via a central line is preferred. Recommendations may vary among individual products and countries (refer to local detailed guidelines).
Reconstitution: Concentrated solution for infusion: Adults and children: Dilute with dextrose 5% inj or other compatible IV fluids (e.g. dextrose 10% inj, dextrose 5% and NaCl 0.45% inj, NaCl 0.9% solution) up to a Max concentration of 5,000 mcg/mL. Neonates: Dilute with dextrose 5% inj or other compatible IV solutions to a standard concentration of 2,000 mcg/mL. Refer to local detailed product guidelines for the rates of infusion based on concentration and further compatible infusion fluids.
Incompatibility: Incompatible with alkaline solutions (e.g. Na bicarbonate), aminophylline, aciclovir, alteplase, bretylium, Ca chloride, Ca gluconate, cefalotin, cefazolin, diazepam, digoxin, furosemide, etacrynic acid, bumetanide, insulin, heparin, warfarin, Mg sulfate, K chloride, hydrocortisone Na succinate, penicillin, phenytoin, thiopental Na, streptokinase, verapamil, and solutions containing both Na metabisulfite and ethanol.

Intravenous
Stress echocardiography
Adult: As an alternative to physical exercise: Initially, 5 mcg/kg/min, increased every 3 minutes to 10 mcg/kg/min, then 20 mcg/kg/min, then 30 mcg/kg/min, and then 40 mcg/kg/min until a diagnostic endpoint is achieved. Doses are given via continuous IV infusion. Consider co-administration with atropine if no diagnostic endpoint is reached. Dosing discontinuation may be required according to individual diagnostic endpoints (refer to detailed product guidelines).
Reconstitution: Concentrated solution for infusion: Adults and children: Dilute with dextrose 5% inj or other compatible IV fluids (e.g. dextrose 10% inj, dextrose 5% and NaCl 0.45% inj, NaCl 0.9% solution) up to a Max concentration of 5,000 mcg/mL. Neonates: Dilute with dextrose 5% inj or other compatible IV solutions to a standard concentration of 2,000 mcg/mL. Refer to local detailed product guidelines for the rates of infusion based on concentration and further compatible infusion fluids.
Incompatibility: Incompatible with alkaline solutions (e.g. Na bicarbonate), aminophylline, aciclovir, alteplase, bretylium, Ca chloride, Ca gluconate, cefalotin, cefazolin, diazepam, digoxin, furosemide, etacrynic acid, bumetanide, insulin, heparin, warfarin, Mg sulfate, K chloride, hydrocortisone Na succinate, penicillin, phenytoin, thiopental Na, streptokinase, verapamil, and solutions containing both Na metabisulfite and ethanol.

Mechanical obstruction affecting ventricular filling and/or outflow, such as constrictive pericarditis, pericardial tamponade, severe aortic stenosis, and hypertrophic cardiomyopathy with outflow tract obstruction (previously known as idiopathic hypertrophic subaortic stenosis [IHSS]); phaeochromocytoma. Additional contraindications when used for stress echocardiography: Recent MI (within 30 days), unstable angina, main left coronary artery stenosis, haemodynamically significant cardiac valvular defect, severe heart failure (NYHA class III or IV), patients at risk for or with a medical history of clinically significant or chronic arrhythmia (especially recurrent persistent ventricular tachycardia), uncontrolled arrhythmia including uncontrolled aortic dissection and aneurysm, inadequately treated or uncontrolled arterial hypertension, hypovolaemia, poor sonographic imaging conditions; acute pericarditis, myocarditis or endocarditis.

Patient with active myocardial ischaemia, recent MI, cardiogenic shock complicated by severe hypotension, atrial fibrillation, arterial hypertension; electrolyte imbalance, diabetes mellitus, hyperthyroidism. Withhold antianginal therapy for 12 hours prior to dobutamine stress echocardiography. Elderly. Pregnancy and lactation. Monitoring Parameters Correct hypovolaemia before and throughout treatment. Closely monitor blood pressure, heart rate, ECG, cardiac output, haemodynamic parameters (e.g. central venous pressure, pulmonary capillary wedge pressure, mean arterial pressure), urine output and infusion rate. Obtain renal function test, electrolytes (e.g. serum K level), and blood glucose. When used for stress echocardiography: Continuously monitor all wall areas via echocardiography, ECG, and blood pressure.

Significant: Increased systolic blood pressure and heart rate, ventricular arrhythmias (e.g. non-sustained ventricular tachycardia, ventricular fibrillation, supraventricular arrhythmia), precipitation or exacerbation of ventricular ectopic activity (dose-related), hypotension secondary to vasodilation; hypersensitivity reactions (e.g. fever, skin rash, eosinophilia, bronchospasm); drug tolerance (when infused continuously for >72 hours). Stress cardiomyopathy (when used during cardiac stress testing). Blood and lymphatic system disorders: Platelet aggregation inhibition (prolonged administration). Cardiac disorders: Angina pectoris, palpitation, chest pain, coronary artery spasm. Gastrointestinal disorders: Nausea. General disorders and administration site conditions: Localised phlebitis at inj site, local inflammation. Investigations: ECG ST segment elevation. Metabolism and nutrition disorders: Rarely, hypokalaemia. Nervous system disorders: Headache, paraesthesia, tremor, myoclonic spasm. Renal and urinary disorders: Increased urinary urgency (high doses). Respiratory, thoracic and mediastinal disorders: Dyspnoea, asthma. Skin and subcutaneous tissue disorders: Exanthema. Vascular disorders: Hypertension.
Potentially Fatal: Rarely, acute cardiac rupture (when used during cardiac stress testing).

Symptoms: Headache, nausea, vomiting, anorexia, anxiety, tremor, palpitation, shortness of breath, anginal pain, and non-specific chest pain. Hypotension, supraventricular or ventricular arrhythmia, ventricular fibrillation and myocardial ischaemia may also occur. Management: Establish airway and ensure oxygenation and ventilation. Carry out resuscitation procedures immediately. Closely monitor vital parameters and maintain the balance of blood gases and serum electrolytes. Administer lidocaine or propranolol for severe ventricular arrhythmias. Treat angina with sublingual nitrates or using shot-active β-blockers (e.g. esmolol). Reduce the dose or terminate the IV infusion if a hypertensive reaction occurs.

Sympathomimetic effect may be diminished by β-blockers (e.g. propranolol, metoprolol). May result in a greater increase in cardiac output when given with venous-acting vasodilators (e.g. Na nitroprusside, nitrates). May cause a more distinct increased pressure and decreased/no change of ventricular filling pressure when given with dopamine. May increase myocardial excitability and the risk of ventricular extrasystoles with inhaled anaesthetics (e.g. halogenated anaesthetics, cyclopropane). Effects may be enhanced by entacapone. May cause prolonged hypertension and increased incidence of arrhythmias with MAOIs. Concomitant use of high dobutamine doses with ACE inhibitors (e.g. captopril) may cause increased cardiac output accompanied by elevated myocardial oxygen consumption. Co-administration with antianginal therapy may result in less pronounced or non-existent ischaemic reactions (when used for stress echocardiography).

Dobutamine is a sympathomimetic agent that is structurally similar to dopamine. It directly stimulates myocardial β₁-adrenergic receptors mainly by the (+) enantiomer and some α₁ receptors by (-) enantiomer, thereby leading to increased myocardial contractility and heart rate. It also has a mild agonist effect on β₂- and α₁-adrenergic receptors resulting in minimal activity to systemic vasculature.
Onset: Within 2 minutes.
Absorption: Time to peak plasma concentration: 10 minutes.
Distribution: Volume of distribution: 0.2 L/kg.
Metabolism: Metabolised in tissues and the liver by COMT into 3-O-methyldobutamine (major inactive metabolite) and via conjugation into glucuronic acid.
Excretion: Mainly via urine, as metabolites; faeces (small amounts). Plasma elimination half-life: Approx 2-3 minutes.

Intravenous: Store between 20-25°C. Do not refrigerate or freeze. Protect from light. Diluted solutions: Stable for 24 hours when stored at 25°C. May exhibit a pink discolouration that may become darker over time due to slight oxidation (this causes no significant loss of potency).

Cardiac Drugs

C01CA07 - dobutamine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of heart failure.