Low dose - Dopaminergic effect: renal, mesenteric and cerebral vasodilation - improves urine output (very unlikely to be ordered in this dose for prehospital care).
Medium dose - β (beta) effect: Increased Heart rate, increased force of cardiac contraction -= i.e. +ve chronotropic and +ve inotropic effects
High dose - α (alpha) effect: vasoconstriction
Onset - 2 to 5 minutes
Peak - Unknown
Half-life - 2 minutes
Duration - less than 10 minutes
Symptomatic hypotension in the absence of hypovolemia e.g. cardiogenic shock, bradyarrhythmia, septic shock, renal failure, etc.
Pheochromocytoma (A rare tumor involving the adrenal gland, characterized by high levels of circulating catecholamines).
Extreme caution must be used if patient on MAO inhibitor.
May increase heart rate and induce supraventricular or ventricular tachycardia.
May compromise cardiac output.
Extravasation will result in tissue necrosis (ensure IV is patent).
Drug to Drug interactions
Increased sympathomimetic effects seen in patients on MAO inhibitors may lead to hypertensive crisis, coma or seizures - consult with BHP. Dopamine may have to be started at a lower dose for patients on MAOIs.
The starting dosage of dopamine may need to be decreased by 10% or more for patients on MAOIs
2 µg-5 µg/kg/min = dopaminergic effect
5 µg-10 µg/kg/min = β (beta) effect
10 µg - 20 µg/kg/min = α (alpha) effect
For the treatment of the hemodynamically unstable patient, the dose range is 5-20 µg/kg/min
Dopamine is generally titrated in increments of 2 - 5 µg/kg/min q 2-5 min to effect.
Same as adult
When administering a dopamine infusion, an infusion pump should be used (ideal), or an in-line Buretrol (2nd best), or a minidrip (last choice). Fill Buretrol with 50 ml of the dopamine solution from the pre-mixed bag. Then close the Buretrol line off to the bag. The appropriate drip rate should then be controlled via the IV tubing.
200 mg in a 250 cc bag will yield a concentration of 800 µg per cc (single strength).
400 mg in a 250 cc bag will yield a concentration of 1600 µg per cc (double strength).
Dopamine is most often used in the prehospital setting for post-arrest hypotension.