DOBUTAMINE

 Pharmacologic class: Sympathomimetic

 Therapeutic class: Inotropic
 Dobutamine stimulates heart muscle and improves blood flow by helping the
heart pump better.
 To treat low cardiac output and heart failure short term
 Dobutamine is a beta-1 agonist used to treat cardiac decompensation in
patients with organic heart disease or from cardiac surgery. A beta-1
agonist catecholamine that has cardiac stimulant action without evoking
vasoconstriction or tachycardia.
Indications:
 Beta 1 effect: enhance force of myocardial contractility , increasing the heart rate
(Dobutamine's ionotropic effect increases contractility, leading to decreased end-
systolic volume and, therefore, increased stroke volume. Increase in stroke
volume leads to an augmentation of the cardiac output of the heart.)
 Beta 2 effect: mild vasodilation
(dobutamine have some beta-2 activity, which contributes to the reduction in the
systemic vascular resistance, whose vasoconstrictive effects are negated by the
baroreceptor mediated response and beta-2 activity.)
 Temporary intravenous inotropic support
(Dobutamine can be used as temporary intravenous inotropic support until
the patient receives more definitive treatment, such as coronary
revascularization, mechanical circulatory support, or heart transplant.)

Pharmacokinetics:
 Absorption: administered only intravenously
 Metabolism : liver and some tissues
 Excretion: kidneys thru urine
 Half life: 2 minutes

Precautions:

 History of hypertension (↑ risk of exaggerated pressor response)

 MI (avoid giving dobutamine to patients with acute MI because it can intensify or
extend myocardial ischemia)
 Atrial fibrillation (pretreatment with digoxin recommended)
  History of ventricular atopic activity (may be exacerbated)
 Hypovolemia (correct before administration)
 Pregnancy (pregnancy Category B. Dobutamine is not expected to harm an
unborn baby, It is not known whether dobutamine passes into breast milk or if it
could harm a nursing baby.)

Adverse Reactions/Side Effects

 CV: hypertension, increased heart rate, premature ventricular contractions,

angina pectoris, arrhythmias, hypotension, palpitations
 GI: nausea, vomiting
 Local: phlebitis
 Neuro: headache
 Resp: shortness of breath
 Misc: hypersensitivity reactions, nonanginal chest pain

Interactions:

 + Nitroprusside (may have a synergistic effect on ↑ cardiac output)

 + Beta Blockers (may negate the effect of dobutamine)
 + Anesthetics (Cyclopropane, Halothane)- (↑ risk of arrhythmias or hypertension
with some anesthetics)
 + MAO Inhibitors, oxytocin & Tricyclic antidepressants

NURSING COSIDERATION:

1. Monitor hemodynamics: hypertension, ↑HR, PVCs

2. Skin reactions may occur with hypersensitivity
3. Beta blockers may negate therapeutic effects of dobutamine
4. Monitor cardiac output & peripheral pulses before, during, and after therapy
5. DO NOT confuse dobutamine with dopamine
6. Monitor potassium concentrations during therapy
7. Monitor urine output hourly

DOSAGE & PREPARATION:

Usual Adult Dose for Congestive Heart Failure:

1. Initial dose: 0.5 to 1 mcg/kg/min IV infusion

2. Maintenance dose: 2 to 20 mcg/kg/min IV infusion
3. Maximum dose: 40 mcg/kg/min IV infusion
FORMULA FOR DOBUTAMINE COMPUTATION:

Rate of infusion:
= Desired Dose X Quantity X Time (min) X wt. (kg)
Available Dose X 1000
= ml/ hour

Sample Situation:

Patient Juan a 75 years old male was admitted on CCU due to cardiogenic shock. The
doctor ordered to start dobutamine infusion at 2.5mcg/kg/min. The pt weighs 80kgs.
Your available stock is 250mg/ 250ml. How will you compute for the rate of infusion?

Solution:

= Desired Dose X Quantity X Time (min) X wt. (kg)

Available Dose X 1000
= 2.5mcg X 250 ml X 60 mins X 80 kgs.
250 mg X 1000
= 3000000
250000

= 12 ml/ hour