DOBUTAMINE

INTRODUCTION

• Dobutamin: Is a beta-1 agonist catecholamine that has cardiac stimulant action

without evoking vasoconstriction or tachycardia.

• It is proposed as a cardiotonic after myocardial infarction or open heart surgery.

 Pharmacologic Category

• Dobutamine is Adrenergic Agonist Agent; Inotrope

• it has Strong beta1 and weak beta2/alpha effects, resulting in increased cardiac
output, blood pressure, and heart rate, as well as decreased peripheral vascular
resistance
 DOBUTAMINE: MECHANISM OF ACTION

• Dobutamine is a pharmacological agent with ionotropic and chronotropic effects

depending on the dose.

• By binding and activating the β-1 receptors selectively, inotropic effects are
achieved on the myocardium.

• The ionotropic effect of dobutamine enhances contractility, which in turn causes a

decrease in end-systolic volume and an increase in stroke volume.

• The heart's cardiac output is increased by the increase in stroke volume.

 INTERACTION

• Concomitant use of Dobutamine & Nitroprussside results in a higher cardiac out

put and lower pulmonary aedge than when either of the drug is used alone
 DOBUTAMINE: INDICATIONS

For patients with

• Decompensated congestive heart failure

• Cardiac surgery

• Septicemia

• Myocardial stress testing

 CONTRAINDICATIONS

Dobutamine is contraindicated for:

• Patients with ideopatic subaortic stenosis and

• Patients who have previous manifestation of hypersensitivity to dobutamine.

 Dobutamine: available dose

• The medication is available as dobutamine hydrochloride 1 mg/mL, 2 mg/mL, and

4 mg/mL in 250 ml and 250 mg/20 mL IV solution.
Dobutamine: Dose & Administration

Adult dose
 for patients with Cardiac Decompensation

• 0.5-1 mcg/kg/min IV continuous infusion initially, then 2-20 mcg/kg/min;

not to exceed 20 mcg/kg/min
 for patients with Low Cardiac Output (Off-label) as inotropic support

• 2-20 mcg/kg/min IV or IO; titrate to desired effect; not to exceed 20

mcg/kg/min
Pediatric dose
For patients with Decompensated heart failure.

• 0.5-1 mcg/kg/min IV continuous infusion initially, then 2-20 mcg/kg/min;

not to exceed 20 mcg/kg/min
 DOBUTAMINE: ADVERSE EFFECT

• Chest pain • Vomiting

• Tachycardia • Tingling sensation

• Paraesthesia
• Angina
• Dyspnea
• Ectopic beats
• Headache
• Palpitations
• Hypersensitivity ( rash, broncospasm and fever)
• Hypertension • Hypokalemia

• Nausia
NURSING INTERVENTION

To optimize hemodynamics, correct hypovolemia if needed.

 administer the drug throgh large vein.

 During administration of dobutamine, monitor

• Blood pressure continuously;

• Pulmonary wedge pressure and

• Cardiac output should be monitored whenever possible to aid safe and

effective infusion of dobutamine in 5% dextrose injection.
 References

• https://www.uptodate.com/contents/dobutamine-drug-information?
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kp_tab=drug_general&display_rank=1#F161962
• Alhayek S, Preuss CV. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL):
Aug 14, 2023. Beta 1 Receptors.
• Kislitsina ON, Rich JD, Wilcox JE, Pham DT, Churyla A, Vorovich EB, Ghafourian K,
Yancy CW. Shock - Classification and Pathophysiological Principles of Therapeutics.
Curr Cardiol Rev. 2019;15(2):102-113.
• https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021201s040lbl.pdf
• https://reference.medscape.com/drug/dobutamine-342434#10