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Dobutamine

Classification

Adrenergic agonist
Inotrope

Indications

CCP: Inotropic agents may be considered in patients with a low cardiac index and low BP, but without hypotension.

CCP: Short-term management of patients with cardiogenic decompensation.

Contraindications

Hypersensitivity to dobutamine or sulfites (some contain sodium metabisulfate), or any component of the formulation
hypertrophic cardiomyopathy with outflow tract obstruction (formerly known as idiopathic hypertrophic subaortic stenosis).

Adult dosages

CCP: Inotropic support

2-20 mcg/kg/min IV max dose 20 mcg/kg/min

Pediatric Considerations And Dosing

CCP: Inotropic support

2-20 mcg/kg/min IV max dose 20 mcg/kg/min

Mechanism Of Action

Dobutamine, a racemic mixture, stimulates myocardial beta₁-adrenergic receptors primarily by the (+) enantiomer.
Some alpha₁ receptor agonism by the (-) enantiomer, resulting in increased contractility and heart rate.
Stimulates both beta₂- and alpha₁-receptors in the vasculature. Although beta₂ and alpha₁ adrenergic receptors are also activated, the effects of beta₂ receptor activation may equally offset or be slightly greater than the effects of alpha₁ stimulation, resulting in some vasodilation in addition to the inotropic and chronotropic actions.
Lowers central venous pressure and wedge pressure, but has little effect on pulmonary vascular resistance.

Pharmacokinetics

Onset of action: IV: 1 to 10 minutes
Peak effect: 10 to 20 minutes
Metabolism: In tissues and hepatically to inactive metabolites
Half-life elimination: 2 minutes

Adverse Effects

Cardiovascular: Increased heart rate
- increased systolic blood pressure
- ventricular premature contractions
- angina pectoris
- chest pain
- palpitations
- hypotension
Central nervous system: Headache
Gastrointestinal: Nausea
Respiratory: Dyspnea
Endocrine & metabolic: Decreased serum potassium

Overdose

Discontinue and assess.
Supportive care as required.

Warning And Precautions

Arrhythmias: Ventricular arrhythmias, including nonsustained ventricular tachycardia and supraventricular arrhythmias.
BP effects: An increase in BP is more common due to augmented cardiac output, but occasionally a patient may become hypotensive.
Heart failure complications: An increased risk of hospitalization and death has been observed with prolonged use in New York Heart Association Class III/IV heart failure patients.
Active myocardial ischemia/myocardial infarction (post): Use with caution in patients with active myocardial ischemia or recent myocardial infarction; can increase myocardial oxygen demand.
Monoamine oxidase inhibitors: Use with extreme caution in patients taking monoamine oxidase inhibitors; prolong hypertension may result from concurrent use.

Drug Interactions

AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Beta-Blockers: May diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy

Calcium Salts: May diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification

COMT Inhibitors: May increase the serum concentration of COMT Substrates. Risk C: Monitor therapy

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Risk D: Consider therapy modification

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy