Dobutamine

General

• Type: Vasopressors
  • Technically an inotrope as beta 2 stimulation causes vasodilation
  • Should use in combination with a vasopressor (eg norepinephrine) to avoid hypotension
• Dosage Forms:
• Common Trade Names:

Adult Dosing

Dosing

• 2-20mcg/kg/min
  • 10mcg works for most
• May use in peripheral IV

Rate of Titration

• Q2-5 min

Special Populations

• Pregnancy Rating: B
• Lactation:
  • Unknown if Dobutamine passes into breast milk
• Renal Dosing
  • Adult
    • Not defined
  • Pediatric
    • Not defined
• Hepatic Dosing
  • Adult
    • Not defined
  • Pediatric
    • Not defined

Contraindications

• Allergy to class/drug

Adverse Reactions

• Tachyarrhythmias
• Myocardial ischemia
• Hypotension as β₂ effect may result in vasodilation
  • Caution if SBP <90

Pharmacology

• Half-life:
  • 2 minutes
• Metabolism:
  • In tissues and hepatically
• Excretion:
  • Urine as metabolites
• Mechanism of Action:β₁ stimulation with variable BP effects

Primary Receptor

• β₁
• β₂

Relative Effects

• ↑↑↑SV
• ↑↑HR → increases oxygen demand of heart → can worsen ischemia
• ↓SVR (transient, from β₂ agonism)

Notes

Indications

• Cardiogenic shock
  • initial agent in low-output heart failure without requiring BP support
• Tricyclic overdose
• septic shock with low cardiac output to improve blood flow

See Also

http://www.atsjournals.org/doi/abs/10.1164/rccm.201006-0972CI?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#readcube-epdf