dopamine (Rx)

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

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

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.

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%)

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