dopamine (Rx)

Brand and Other Names:Intropin
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

infusion solution, in D5W

  • 80mg/100mL
  • 160mg/100mL
  • 320mg/100mL

injectable solution

  • 40mg/mL
  • 80mg/mL
  • 160mg/mL
more...

Hemodynamic Conditions

Treatment of hypotension, low cardiac output, poor perfusion of vital organs; used to increase mean arterial pressure in septic shock patients who remain hypotensive after adequate volume expansion

1-5 mcg/kg/min IV (low dose): May increase urine output and renal blood flow  

5-15 mcg/kg/min IV (medium dose): May increase renal blood flow, cardiac output, heart rate, and cardiac contractitlity

20-50 mcg/kg/min IV (high dose): May increase blood pressure and stimulate vasoconstriction; may not have a beneficial effect in blood pressure; may increase risk of tachyarrhythmias

May increase infusion by 1-4 mcg/kg/min at 10-30 min intervals until optimum response obtained

Titrate to desired response

Dosing Considerations

Strong beta1-adrenergic, alpha-adrenergic, and dopaminergic effects are based on dosing rate

Beta1 effects: 2-10 mcg/kg/min

Alpha effects: >10 mcg/kg/min

Dopaminergic effects: 0.5-2 mcg/kg/min

Dosage Forms & Strengths

infusion solution, in D5W

  • 80mg/100mL
  • 160mg/100mL
  • 320mg/100mL

injectable solution

  • 40mg/mL
  • 80mg/mL
  • 160mg/mL
more...

Hemodynamic Conditions

Treatment of hypotension

1-5 mcg/kg/min IV, increased to 5-20 mcg/kg/min; not to exceed 50 mcg/kg/min  

Titrate to desired response

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Interactions

Interaction Checker

and dopamine

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            Adverse Effects

            Frequency Not Defined

            Cardiovascular: Ventricular arrhythmia, atrial fibrillation (at very high doses), ectopic beats, tachycardia, anginal pain, palpitation, cardiac conduction abnormalities, widened QRS complex, bradycardia, hypotension, hypertension, vasoconstriction

            Respiratory: Dyspnea

            Gastrointestinal: Nausea, vomiting

            Metabolic/nutritional: Azotemia

            Central nervous system: Headache, anxiety

            Endocrine: Piloerection

            Ocular: Increased intraocular pressure; dilated pupils

            Gangrene of extremities has occurred when high doses were administered for prolonged periods or in patients with occlusive vascular disease receiving low doses of dopamine hydrochloride

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            Warnings

            Black Box Warnings

            May cause peripheral ischemia in patients with history of occlusive vascular disease

            If ischemia occurs, prevent sloughing and necrosis in ischemic areas by infiltrating areas as soon as possible with 5-10 mg of phentolamine (adrenergic blocking agent) in 10-15 mL of saline solution

            Contraindications

            Hypersensitivity to dopamine, pheochromocytoma, ventricular fibrillation, uncorrected tachyarrhythmias

            Cautions

            Use caution in angina pectoris, extravasation, hypovolemia, occlusive vascular disease, ventricular arrhythmias, recent use of monoamine oxidase inhibitors, sensitivity to sulfites

            Drug is inactivated by alkali

            May cause increases in heart rate

            Use with caution after myocardial infarction

            Monitor blood pressure closely

            Use caution in patients taking MAO inhibitors; prolong hypertension may occur with concurrent use

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Unknown whether drug is excreted into breast milk; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Endogenous catecholamine, acting on both dopaminergic and adrenergic neurons

            Low dose stimulates mainly dopaminergic receptors, producing renal and mesenteric vasodilation; higher dose stimulates both beta1-adrenergic and dopaminergic receptors, producing cardiac stimulation and renal vasodilation; large dose stimulates alpha-adrenergic receptors

            Absorption

            Onset: 5 min (adults)

            Duration: <10 min

            Distribution

            Vd: 1.8-2.45 L/kg

            Metabolism

            Metabolized in liver, kidney, and plasma by monoamine oxidase and catechol-O-methyl transferase

            Metabolites: Norepinephrine (active), inactive metabolites

            Elimination

            Half-life: 2 min

            Total body clearance: 115 mL/kg/min

            Excretion: Urine (80%)

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            Administration

            IV Incompatibilities

            Solution: Sodium bicarbonate 5%

            Additive: Acyclovir, alteplase, amphotericin B, ampicillin, gentamicin(?), metronidazole/sodium bicarbonate, penicillin G potassium

            Y-site: Acyclovir, aldesleukin(?), alteplase, amphotericin B cholesteryl sulfate, cefepime, furosemide(?; depends on formulation), heparin (in D5W), indomethacin, insulin, thiopental, TNA #222-223

            IV Compatibilities

            Solution: Most common solvents (eg, D5W, D10W, dextrose/saline, LR, NS, sodium lactate 1/6M)

            Additive (partial list): Aminophylline, calcium gluconate, ciprofloxacin, dobutamine, heparin, hydrocortisone, lidocaine, nitroglycerin, potassium chloride, verapamil

            Syringe: Caffeine, doxapram, heparin, ranitidine

            Y-site (partial list): Amiodarone, cisatracurium, diltiazem, dobutamine, epinephrine, esmolol, fentanyl, heparin (in NS), hydrocortisone sodium succinate, labetalol, lidocaine, lorazepam, morphine sulfate, nitroglycerin, ondansetron, potassium chloride, propofol, tacrolimus, verapamil, vitamins B and C, warfarin, zidovudine

            Not specified: Carbenicillin, tetracycline, iron salts, oxidizing agents, alkaline solutions

            IV Preparation

            Dilute 200-400 mg in 250-500 mL of compatible diluent (eg, D5W, NS, LR, D5/NS, D5/LR); typical concentration range is 0.8-1.6 mg/mL, though up to 3.2 mg/mL has been used

            Drug is stable for 24 hours after dilution

            Premixed solution may be administered without dilution

            Do not use if solution is darker than slightly yellow; discoloration to brown, pink, or purple indicates decomposition

            IV Administration

            Infuse via central line; umbilical arterial catheter is not recommended

            Administer in large vein (eg, antecubital)

            Use infusion pump to control flow rate

            Titrate dosage to desired hemodynamic values or optimal urine flow

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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