dobutamine (Rx)

1-10%

Tachyarrhythmia (~10%)

Hypertension (7.5%)

Eosinophilic myocarditis (≤7%)

Premature ventricular beats (5%; dose related)

Angina (1-3%)

Dyspnea (1-3%)

Fever (1-3%)

Headache (1-3%)

Nausea (1-3%)

Palpation (1-3%)

Frequency Not Defined

Cardiac dysrhythmia

Exacerbation of coronary arteriosclerosis

Hypokalemia

Injection-site reactions

Syncope

10- to 20-mm Hg increase in systolic blood pressure and increase in heart rate of 5 to 15 beats/min

Contraindications

Hypersensitivity to drug or components

Idiopathic hypertrophic subaortic stenosis

Cautions

To optimize hemodynamics, correct hypovolemia if needed

Clinical experience with dobutamine following myocardial infarction has been insufficient to establish safety of drug for this use; there is concern that any agent that increases contractile force and heart rate may increase size of infarction by intensifying ischemia, but not known whether dobutamine does so

Severe coronary artery disease (CAD)

Hypertension common; hypotension may also occur

May cause a marked increase in heart rate or blood pressure,especially systolic pressure; because dobutamine facilitates atrioventricular conduction, patients with atrial fibrillation are at risk of developing rapid ventricular response; in patients who have atrial fibrillation with rapid ventricular response, a digitalis preparation should be used prior to institution of therapy with dobutamine; patients with pre-existing hypertension appear to face an increased risk of developing an exaggerated pressure response

During administration of dobutamine, monitor blood pressure continuously; pulmonary wedge pressure and cardiac output should be monitored whenever possible to aid safe and effective infusion of dobutamine in 5% dextrose Injection, USP

Ventricular ectopy exacerbation may occur

Pregnancy category: B

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

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.

Mechanism of Action

Strong beta1 and weak beta2/alpha effects, resulting in increased cardiac output, blood pressure, and heart rate, as well as decreased peripheral vascular resistance

Absorption

Onset: 1-10 min

Duration: 10 min

Time to peak effect: ~15 min

Distribution

Vd: 0.2 L/kg

Metabolism

Metabolized in tissues and liver by catechol-O-methyl transferase

Metabolites: Glucuronide conjugate, 3-0-methylated dobutamine (inactive)

Elimination

Half-life: 2 min

Clearance: 90 mL/kg/min

Excretion: Urine

IV Incompatibilities

Solution: Sodium bicarbonate 5%

Additive: Acyclovir, alteplase, aminophylline, bretylium(?), bumetanide, calcium chloride(?), calcium gluconate, diazepam, digoxin, floxacillin, furosemide, heparin(?), insulin, magnesium sulfate, phenytoin, potassium phosphates, sodium bicarbonate

Syringe: Doxapram

Y-site: Acyclovir, alatrofloxacin, alteplase, aminophylline, amphotericin B cholesteryl sulfate, cefepime, foscarnet, furosemide(?), heparin(?), indomethacin, phytonadione, piperacillin-tazobactam, thiopental, warfarin

IV Compatibilities

Solution: Most common solvents (D5/LR, D5/NS, D5W, LR, NS)

Additive (partial list): Amiodarone, atropine, ciprofloxacin, dopamine, epinephrine, flumazenil, hydralazine, lidocaine, meperidine, morphine sulfate, nitroglycerin, nitroglycerin with nitroprusside(?), norepinephrine, potassium chloride(?), verapamil (incompatible at higher concentrations)

Syringe: Caffeine citrate, heparin, ranitidine

Y-site (partial list): Amiodarone, atracurium, calcium gluconate, ciprofloxacin, diazepam, diltiazem, dopamine, epinephrine, fentanyl, inamrinone, labetalol, lidocaine, lorazepam, magnesium sulfate, midazolam(?), morphine sulfate, nitroglycerin, norepinephrine, potassium chloride, propofol, sodium nitroprusside, tacrolimus, vasopressin, verapamil, zidovudine

IV Preparation

Solution: Dilute 250 mg in 250 mL of compatible solution to yield final concentration of 1000 mcg/mL; not to exceed 5000 mcg/mL

IV Administration

Infuse into large vein via infusion pump

Storage

Store intact vials at room temperature; protect from excessive heat or freezing conditions

Diluted solutions may be stored for 24 hours