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Pronunciation
(doe BYOO ta meen)
Generic Available (U.S.)
Yes
Index Terms
Brand Names: Canada
Pharmacologic Category
Use: Labeled Indications
Short-term management of patients with cardiac decompensation
Use: Unlabeled
Positive inotropic agent for use in myocardial dysfunction related to sepsis; stress echocardiography
Pregnancy Risk Factor
B
Pregnancy Considerations
Adverse events have not been observed in animal reproduction studies.
Lactation
Excretion in breast milk unknown/use caution
Contraindications
Hypersensitivity to dobutamine or sulfites (some contain sodium metabisulfate), or any component of the formulation; idiopathic hypertrophic subaortic stenosis (IHSS)
Warnings/Precautions
Concerns related to adverse effects:
• Blood pressure effects: An increase in blood pressure is more common, but occasionally a patient may become hypotensive.
• Tachycardia: May increase heart rate.
• Ventricular ectopy: May exacerbate ventricular ectopy.
Disease-related concerns:
• Aortic stenosis: Ineffective therapeutically in the presence of mechanical obstruction such as severe aortic stenosis.
• Atrial fibrillation: Patients with atrial fibrillation may experience an increase in ventricular response.
• Hypovolemia: If needed, correct hypovolemia first to optimize hemodynamics.
• Myocardial infarct (post): Use with caution in patients post-MI; can increase myocardial oxygen demand.
Concurrent drug therapy issues:
• Monoamine oxidase inhibitors (MAO-I): Use with extreme caution in patients taking MAO inhibitors; prolong hypertension may result from concurrent use.
Dosage form specific issues:
• Sodium sulfite: Product may contain sodium sulfite.
Special populations:
• Elderly: Use with caution in the elderly; start at lower end of the dosage range.
Other warnings/precautions:
• Diagnostic testing: Dobutamine in combination with stress echo may be used diagnostically.
Adverse Reactions
Incidence of adverse events is not always reported.
Cardiovascular: Increased heart rate, increased blood pressure, increased ventricular ectopic activity, hypotension, premature ventricular beats (5%, dose related), anginal pain (1% to 3%), nonspecific chest pain (1% to 3%), palpitation (1% to 3%)
Central nervous system: Fever (1% to 3%), headache (1% to 3%), paresthesia
Endocrine & metabolic: Slight decrease in serum potassium
Gastrointestinal: Nausea (1% to 3%)
Hematologic: Thrombocytopenia (isolated cases)
Local: Phlebitis, local inflammatory changes and pain from infiltration, cutaneous necrosis (isolated cases)
Neuromuscular & skeletal: Mild leg cramps
Respiratory: Dyspnea (1% to 3%)
Metabolism/Transport Effects
Substrate of COMT
Drug Interactions
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Calcium Salts: May diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy
Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
COMT Inhibitors: May decrease the metabolism of COMT Substrates. Risk C: Monitor therapy
Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination
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
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Storage
Store reconstituted solution under refrigeration for 48 hours or 6 hours at room temperature. Stability of parenteral admixture at room temperature (25°C) is 48 hours; at refrigeration (4°C) stability is 7 days.
Reconstitution
Remix solution every 24 hours. Pink discoloration of solution indicates slight oxidation but no significant loss of potency.
Standard adult diluent: 250 mg/500 mL D5W; 500 mg/500 mL D5W.
Compatibility
Per manufacturer, do not give through same I.V. line as heparin, hydrocortisone sodium succinate, cefazolin, or penicillin. Incompatible with heparin, cefazolin, penicillin, and in alkaline solutions (sodium bicarbonate).
Stable in D5LR, D51/2NS, D5NS, D5W, D10W, LR, 1/2NS, NS, mannitol 20%; incompatible with sodium bicarbonate 5%; variable stability (consult detailed reference) in peritoneal dialysis solutions.
Y-site administration: Compatible: Alcohol (ethyl), alprostadil, amifostine, amiodarone, anidulafungin, argatroban, atracurium, aztreonam, caffeine citrate, calcium chloride, calcium gluconate, caspofungin, ciprofloxacin, cisatracurium, cladribine, clonidine, dexmedetomidine, diazepam, diltiazem, docetaxel, dopamine, dopamine with lidocaine, dopamine with nitroglycerin, dopamine with nitroprusside, doripenem, doxorubicin liposome, enalaprilat, epinephrine, eptifibatide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, gemcitabine, granisetron, haloperidol, hetastarch in lactated electrolyte injection (Hextend®), hydromorphone, inamrinone, insulin (regular), labetalol, levofloxacin, lidocaine, lidocaine with nitroglycerin, lidocaine with nitroprusside, linezolid, lorazepam, magnesium sulfate, meperidine, milrinone, morphine, nicardipine, nitroglycerin, nitroglycerin with nitroprusside, norepinephrine, oxaliplatin, pancuronium, potassium chloride, propofol, ranitidine, remifentanil, tacrolimus, telavancin, terbutaline, theophylline, thiotepa, tigecycline, tirofiban, vasopressin, vecuronium, verapamil, zidovudine. Incompatible: Acyclovir, alteplase, aminophylline, amphotericin B cholesteryl sulfate complex, foscarnet, indomethacin, micafungin, pantoprazole, pemetrexed, phytonadione, piperacillin/tazobactam, thiopental, warfarin. Variable (consult detailed reference): Bivalirudin, cefepime, ceftazidime, drotecogin alfa, furosemide, heparin, midazolam, nesiritide, nitroprusside, pantoprazole, tenecteplase.
Compatibility in syringe: Compatible: Caffeine citrate, dimenhydrinate, heparin, ranitidine. Incompatible: Doxapram, pantoprazole.
Mechanism of Action
Stimulates beta1-adrenergic receptors, causing increased contractility and heart rate, with little effect on beta2- or alpha-receptors
Pharmacodynamics/Kinetics
Onset of action: I.V.: 1-10 minutes
Peak effect: 10-20 minutes
Metabolism: In tissues and hepatically to inactive metabolites
Half-life elimination: 2 minutes
Excretion: Urine (as metabolites)
Dosage
Administration requires the use of an infusion pump; I.V. infusion: Children and Adults: 2.5-20 mcg/kg/minute; maximum: 40 mcg/kg/minute, titrate to desired response. See table.
Infusion Rates of Various Dilutions of Dobutamine
Desired Delivery Rate
(mcg/kg/min)
Infusion Rate (mL/kg/min)
500 mcg/mL
1000 mcg/mL
2.5
0.005
0.0025
5
0.01
0.005
7.5
0.015
0.0075
10
0.02
0.01
12.5
0.025
0.0125
15
0.03
0.015
Table has been converted to the following text.
I.V. Infusion Guidelines
To deliver 2.5 mcg/kg/minute:
• Using 500 mcg/mL solution; infuse at 0.005 mL/kg/minute.
• Using 1000 mcg/mL solution; infuse at 0.0025 mL/kg/minute.
To deliver 5 mcg/kg/minute:
• Using 500 mcg/mL solution; infuse at 0.01 mL/kg/minute.
• Using 1000 mcg/mL solution; infuse at 0.005 mL/kg/minute.
To deliver 7.5 mcg/kg/minute:
• Using 500 mcg/mL solution; infuse at 0.015 mL/kg/minute.
• Using 1000 mcg/mL solution; infuse at 0.0075 mL/kg/minute.
To deliver 10 mcg/kg/minute:
• Using 500 mcg/mL solution; infuse at 0.02 mL/kg/minute.
• Using 1000 mcg/mL solution; infuse at 0.01 mL/kg/minute.
To deliver 12.5 mcg/kg/minute:
• Using 500 mcg/mL solution; infuse at 0.025 mL/kg/minute.
• Using 1000 mcg/mL solution; infuse at 0.0125 mL/kg/minute.
To deliver 15 mcg/kg/minute:
• Using 500 mcg/mL solution;infuse at 0.03 mL/kg/minute.
• Using 1000 mcg/mL solution;infuse at 0.015 mL/kg/minute.
Administration: I.V.
Always administer via infusion device; administer into large vein.
Administration: I.V. Detail
pH: 2.5-5.5
Monitoring Parameters
Blood pressure, ECG, heart rate, CVP, RAP, MAP; serum glucose, renal function; urine output; if pulmonary artery catheter is in place, monitor CI, PCWP, and SVR
Patient Education
When administered in emergencies, patient education should be appropriate to the situation. If patient is aware, instruct to promptly report chest pain, palpitations, rapid heartbeat, headache, nervousness or restlessness, nausea or vomiting, or respiratory difficulty.
Geriatric Considerations
One study demonstrated beneficial hemodynamic effects in elderly patients; monitor closely.
Additional Information
Dobutamine lowers central venous pressure and wedge pressure but has little effect on pulmonary vascular resistance.
Dobutamine therapy should be avoided in patients with stable heart failure due to an increase in mortality. In patients with intractable heart failure, dobutamine may be used as a short-term infusion to provide symptomatic benefit. It is not known whether short-term dobutamine therapy in end-stage heart failure has any outcome benefit.
Dobutamine infusion during echocardiography is used as a cardiovascular stress. Wall motion abnormalities developing with increasing doses of dobutamine may help to identify ischemic and/or hibernating myocardium.
Anesthesia and Critical Care Concerns/Other Considerations
Evidence-Based Information:
Septic Shock: Septic patients who have been adequately fluid resuscitated and have an adequate mean arterial pressure but low cardiac index (<2.5 L/minute/m2) may require dobutamine. Dobutamine may help reverse tissue hypoperfusion by increasing cardiac output. Increasing cardiac output beyond the normal range has not been shown in clinical trials to improve patient outcome. The 2008 Surviving Sepsis Campaign guidelines recommend the use of dobutamine infusion when myocardial dysfunction is present with the goal of normalizing cardiac output. Avoid trying to increase cardiac index to supranormal levels (Grade 1C).
Early goal-directed therapy in the treatment of severe sepsis and septic shock provides significant survival benefits to this subset of patients. About 14% of the patients in the early goal-directed group received dobutamine. The early goal-directed patients received significantly more fluid, red-cell transfusions, and inotropic support during the initial 6 hours of their visit (Rivers, 2001). The 2008 Surviving Sepsis Campaign guidelines suggest that if central venous (superior vena cava) or mixed venous oxygen saturation of ≥70% or ≥65%, respectively, is not achieved (central venous pressure 8-12 mm Hg) within the first 6 hours of resuscitation, then transfuse packed red blood cells to a hematocrit of ≥30% and/or administer dobutamine (up to 20 mcg/kg/minute) to achieve this goal (Grade 2C).
Cardiovascular Considerations
Dobutamine therapy should be avoided in patients with stable heart failure due to an increase in mortality. In patients with intractable heart failure, dobutamine may be used as a short-term infusion to provide symptomatic benefit. It is not known whether short-term dobutamine therapy in end-stage heart failure has any outcome benefit.
Dobutamine infusion during echocardiography is used as a cardiovascular stress. Wall motion abnormalities developing with increasing doses of dobutamine may help to identify ischemic and/or hibernating myocardium.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
None reported
Mental Health: Effects on Psychiatric Treatment
None reported
Nursing: Physical Assessment/Monitoring
Infusion pump and frequent cardiac monitoring are required.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Infusion, premixed in D5W, as hydrochloride: 1 mg/mL (250 mL); 2 mg/mL (250 mL); 4 mg/mL (250 mL)
Injection, solution, as hydrochloride: 12.5 mg/mL (20 mL, 40 mL)
References
Bax JJ, Poldermans D, Elhendy A, et al, “Improvement of Left Ventricular Ejection Fraction, Heart Failure Symptoms and Prognosis After Revascularization in Patients With Chronic Coronary Artery Disease and Viable Myocardium Detected by Dobutamine Stress Echocardiography,” J Am Coll Cardiol, 1999, 34(1):163-9.
Brierley J, Carcillo JA, Choong K, et al, “Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2007 Update from the American College of Critical Care Medicine,” Crit Care Med, 2009, 37(2):666-88.
Dellinger RP, Levy MM, Carlet JM, et al, “Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008,” [published correction appears in Crit Care Med, 2008, 36(4):1394-6], Crit Care Med, 2008, 36(1):296-327.
Hollenberg SM, Ahrens TS, Annane D, et al, “Practice Parameters for Hemodynamic Support of Sepsis in Adult Patients: 2004 Update,” Crit Care Med, 2004, 32(9):1928-48.
Hunt SA, Abraham WT, Chin MH, et al, “2009 Focused Update Incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation,” J Am Coll Cardiol, 2009, 53(15):e1-90.
Leier CV, Webel J, and Bush CA, “The Cardiovascular Effects of the Continuous Infusion of Dobutamine in Patients With Severe Cardiac Failure,” Circulation, 1977, 56(3):468-72.
Lindenfeld J, Albert NM, Boehmer JP, et al, “HFSA 2010 Comprehensive Heart Failure Practice Guideline,” J Card Fail, 2010, 16(6):e1-194.
Patel MB, Kaplan IV, Patni RN, et al, “Sustained Improvement in Flow-Mediated Vasodilation After Short-Term Administration of Dobutamine in Patients With Severe Congestive Heart Failure,” Circulation, 1999, 99(1):60-4.
Paulman PM, Cantral K, Meade JG, et al, “Dobutamine Overdose,” JAMA, 1990, 264(18):2386-7.
“Practice Parameters for Hemodynamic Support of Sepsis in Adult Patients in Sepsis. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine,” Crit Care Med, 1999, 27(3):639-60. Available at http://www.sccm.org/pdf/Hemodynamic%20Support.pdf
Rich MN, Woods WL, Davila-Roman VG, et al, “A Randomized Comparison of Intravenous Amrinone Versus Dobutamine in Older Patients With Decompensated Congestive Heart Failure,” J Am Geriatr Soc, 1995, 43(3):271-4.
Rivers E, Nguyen B, Havstad S, et al, “Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock," N Engl J Med, 2001, 345(19):1368-77.
International Brand Names
Lexi-Comp.com
Last full review/revision January 2012
Content last modified January 2012
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