Critical Care Trauma Centre

DOBUTAMINE (Dobutrex)

 

Name: DOBUTAMINE (DobutrexR)
Classification: sympathomimetic; inotropic agent
  • synthetic derivative of isoproterenol; decreases afterload 
  • stimulates beta1 adrenergic receptors to increase myocardial contractility 
  • alpha adrenergic receptors increase blood pressure at low dose
Dose: Infusion:
2.5-10 mcg/kg/min (start at low dose and titrate to target cardiac index, venous oxygen saturation or other indicator of cardiac output)
Administration: IV Infusion
500 mg/250 mL dextrose 5%, normal saline 0.9% or Ringer's Lactate
  • Protect from light
  • May turn pink in solution without affecting potency
  • Hypovolemia, acidosis and hypoxemia should be corrected concurrently with therapy
  • Should be weaned off
Adverse Effects:
  • decreased BP (should not be started in hypotensive patients - increased hypotension at doses > 20 mcg/kg/min or in septic patients)
  • tachycardia
  • increased BP (associated with low doses)
  • arrhythmias (usually PVC)
  • increased blood glucose
  • extravasation of drug may cause tissue necrosis (may be Rx with 5-15 mg phentolamine in NS - see phentolamine monograph)
Drug Interactions:
  • dobutamine + other sympathomimetics = increased risk of toxicity
  • dobutamine + theophylline = increased risk of toxicity
  • dobutamine + general anaesthetics = arrhythmias
  • dobutamine + beta blockers = decreased inotropic effect
Monitoring Therapy:
  • IV site
  • continuous heart rate and ECG rhythm
  • blood pressure
  • central or mixed venous oxygen
  • lactate
  • urine output
  • cardiac index if monitored
  • blood glucose
  • blood gases
  • electrolytes
  • urea, creatinine
Adult Critical Care Protocol:
  • May be administered by IV infusion by a nurse in Adult Critical Care.
  • May be titrated by a nurse in Adult Critical Care.
  • Must be administered via central venous access device; in emergency situations may be temporarily infused through a peripheral vasuclar access device until a central venous line can be established.
  • Patient requires placement of an arterial line to monitor BP.
  • Continuous infusions must be administered by infusion device and the pump library must be enabled.
  • Should not be infused via the proximal injectate port (blue) of a pulmonary artery catheter. If this is the only available central venous line, it may be administered through the proximal injectate port but thermodilution cardiac output measurements must not be measured during infusion).


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: September 17, 2018