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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

DOPAMINE

Indication

  • to increase cardiac output, blood pressure and urine flow in the treatment of shock which persists after adequate volume replacement; particularly effective in the treatment of cardiogenic shock
  • also used in the short term management of severe congestive heart failure
  • used often following asphyxia
  • used as an adjunct to colloid to maintain adequate blood pressure when tolazoline is used to treat persistent fetal circulation

Pharmacology

  • dopamine is an endogenous catecholamine; it is the immediate precursor of norepinephrine and has a plasma half life of about 2 minutes
  • dopamine creates multiple effects in the body, depending on its dose
  • at low doses (< 2 mcg/kg/min), dopamine acts predominantly on specific dopaminergic receptors in the renal, mesenteric, coronary and intracerebral vascular beds to cause vasodilation
  • at intermediate doses (2 to 10 mcg/kg/min), beta1-adrenergic receptors are also stimulated and norepinephrine is released from nerve terminals in the myocardium; this produces a positive inotropic effect; overall, there is little change in heart rate, and either reduction or no change in total peripheral resistance
  • at higher doses (> 10 mcg/kg/min), alpha- adrenergic receptors are stimulated and these effects predominate (increased peripheral resistance and renal vasoconstriction)

Side Effects

  • tachycardia, angina, palpitations, vasoconstriction, hypertension, hypotension, dyspnea, vomiting, headache, decreased urine output
  • necrosis and sloughing of tissue at IV site if infiltration occurs
  • ventricular arrhythmias can occur at high doses
  • peripheral circulatory impairment - check colour and temperature of extremities

Precautions

  • monitor systemic pressures; check for circulatory impairment
  • watch for dehydration, monitor intake and output
  • should NOT be inadvertently discontinued, restart infiltrated IVs immediately (drug levels and blood pressure will fall rapidly)
  • monitor IV patency at least every 10-15 minutes
  • local: blanching, tissue ischemia or necrosis may occur with extravasation. Use phentolamine (see phentolamine monograph) if this occurs.

Miscellaneous

  • although it is not recommended that medications and TPN (amino acid/dextrose mixture; lipid) be mixed, in some situations there is no alternative. Dopamine has been reported to be physically compatible by visual inspection when "Y'd" in with a mixture of amino acid/dextrose and lipid. In all instances, however, the IV lines should be carefully inspected for any signs of incompatibility (precipitate, change in colour, haze, etc.)

Dose

  • titrated to patient response - initial dose 5 mcg/kg/min by continuous IV infusion; usual dosage range is 5-20 mcg/kg/min
  • maximum dose - 50 mcg/kg/min or any dose producing tachycardia of 200 beats/minute

Supplied

  • commercial premixed 1600mcg/mL solution as 400mg in 250mL D5W
  • Supplied by pharmacy as standard concentrations:
    • 0.5kg or less   800mcg/mL,  supplied as 40mg in 50mL D5W
    • Over 0.5kg    1600mcg/mL,  supplied as 80mg in 50mL D5W
  • The 1600mcg/mL solution is available as wardstock in the NICU in the main medication fridge as 80mg/50mL syringes
  • In HUGO, choose the NICU continuous infusion orderable with the correct weight category and input the desired therapeutic dose (normalized rate) and the rate per hour will be calculated electronically
  • Standard Concentration references available on the NICU Intranet here.

 

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  3. Trissel L.A.: Handbook on Injectable Drugs, American Society of Hospital Pharmacists 1988.

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