Dobutamine hydrochloride
Trade name: Dobutrex
Drug classes:
• Sympathomimetic
• β1-selective adrenergic agonist
Pregnancy: Category B
Therapeutic actions
Positive inotropic effects are mediated by β1- adrenergic receptors in the heart; increases the force of myocardial contraction with relatively minor effects on heart rate, arrhythmogenesis; has minor effects on blood vessels
Indications
For inotropic support in the short-term treatment of adults with cardiac decompensation due to depressed contractility, resulting from either organic heart disease or from cardiac surgical procedures
Investigational use in children with congenital heart disease undergoing diagnostic cardiac catheterization, to augment CV function
Dosage
Available Forms: Injection 125 mg/mL
Administer only by IV infusion
Titrate on the basis of the patient's homodynamic/renal response
Close monitoring is necessary
Adult
25---15 µg/kg/min IV is usual rate to increase cardiac output; rarely, rates up to 40 µg/kg per minute are needed
IV facts
Preparation: Reconstitute by adding 10 mL Sterile Water for Injection or 5% Dextrose Injection to 250-mg vial If material is not completely dissolved, add 10 mL of diluent Further dilute to at least 50 mL with 5% Dextrose Injection, 09% Sodium Chloride Injection, or Sodium Lactate Injection Store reconstituted solution under refrigeration for 48 h or at room temperature for 6 h Store final diluted solution in glass or via flex container at room temperature Stable for 24 h Do not freeze (Note: drug solutions may exhibit a color that increases with time; this indicates oxidation of the drug, not a loss of potency
Infusion: May be administered through common IV tubing with dopamine, lidocaine, tobramycin, nitroprusside, potassium chloride, or protamine sulfate Titrate rate based on patient response--P, BP, rhythm; use of an infusion pump is suggested
Incompatibilities: Do not mix drug with alkaline solutions, such as 5% Sodium Bicarbonate Injection; do not mix with hydrocortisone sodium succinate, cefazolin, cefamandole, neutral cephalothin, penicillin, sodium ethacrynate; sodium heparin
Y-site Incompatibilities: Do not mix with acyclovir, alteplase, aminophylline, foscarnet
Adverse effects
CNS: Headache
GI: Nausea
CV: Increase in heart rate, increase in systolic blood pressure, increase in ventricular ectopic beats (PVCs), anginal pain, palpitations, shortness of breath
Clinically important interactions
Drug-drug
Increased effects with TCAs (eg, imipramine), furazolidone, methyldopa
Risk of severe hypertension with β-blockers
Decreased effects of guanethidine with dobutamine
Nursing Considerations
Arrange to digitalize patients who have atrial fibrillation with a rapid ventricular rate before giving dobutamine--dobutamine facilitates AV conduction
Monitor urine flow, cardiac output, pulmonary wedge pressure, ECG, and BP closely during infusion; adjust dose/rate accordingly