Adult Dosing
Cardiac decompensation due to organic heart disease or cardiac surgery
- Initial dose: 0.5-1 mcg/kg/min, titrate slowly at an interval of few mins to desired response
- Maintenance dose: 2-20 mcg/kg/min; Max: 40 mcg/kg/min
Note:
- Do not add dobutamine to 5% sodium bicarbonate injection or to any other strongly alkaline solution as dobutamine is inactivated in alkaline solution
- Use more concentrated 1 mg/mL, 2 mg/mL, or 4 mg/mL solutions in patients with fluid retention or when slower rate of infusion is desired
Supportive therapy in Pulmonary embolism [Non-FDA Approved]
- Initial dose: 2.5-5 mcg/kg/min, titrate slowly at an interval of few mins to desired response. Maintenance dose: 2.5-20 mcg/kg/min; Max: 40 mcg/kg/min
Pediatric Dosing
Cardiac decompensation due to organic heart disease or cardiac surgery
- Initial dose: 0.5-1 mcg/kg/min, titrate slowly at an interval of few mins to desired response
- Maintenance dose: 2-20 mcg/kg/min; Max: 40 mcg/kg/min
Note:
- Do not add dobutamine to 5% sodium bicarbonate injection or to any other strongly alkaline solution as dobutamine is inactivated in alkaline solution
- Use more concentrated 1 mg/mL, 2 mg/mL, or 4 mg/mL solutions in patients with fluid retension or when slower rate of infusion is desired
Supportive therapy in Pulmonary embolism [Non-FDA Approved]
- 2.5-15 mcg/kg/min; Max: 40 mcg/kg/min
[Outline]
- Increase in heart rate or blood pressure, especially systolic pressure has been reported with dobutamine therapy; however, reduction in dosage reverses these effects. Patients with pre-existing hypertension are at higher risk.
- Patients with atrial fibrillation are at risk of developing rapid ventricular response. Use digitalis preparation in these patients prior to institution of therapy with dobutamine
- Dobutamine may precipitate or exacerbate ventricular ectopic activity, but rarely causes ventricular tachycardia
- Hypersensitivity, including skin rash, fever, eosinophilia, and bronchospasm have been reported with dobutamine administration
- Dobutamine contains sodium bisulfite which can cause allergic-type reactions, including anaphylactic symptoms and life threatening asthmatic episodes. This occurs more frequently in asthmatic than in nonasthmatic people
- Continuously monitor ECG and blood pressure during the administration of dobutamine and also measure pulmonary wedge pressure and cardiac output whenever possible
- Before administrating dobutamine, hypovolemia should be corrected
- In the presence of marked mechanical obstruction, such as severe valvular aortic stenosis, no improvement is observed with dobutamine therapy
- Mild reduction in serum potassium concentration has been observed with dobutamine, rarely to hypokalemic levels. Consider monitoring serum potassium levels
- Excess administration of potassium-free solutions can result in fluid or solute overloading, resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema
- Monitor changes in fluid balance, electrolyte concentrations and acid-base balance during prolonged parenteral therapy or whenever the condition of the patient warrants
- Dobutamine solution in 5% dextrose should be used cautiously in patients with known diabetes mellitus
Cautions: Use cautiously in
- Atrial fibrillation
- Hypertension
- Diabetes mellitus
- Hypovolemia
- Asthma
- Recent Myocardial Infarction
- Ventricular ectopic activity
Pregnancy Category:B
Breastfeeding: No data available on use of dobutamine during breastfeeding. As dobutamine has poor oral bioavailability and short half-life, it is unlikely to cause any adverse affect in infants based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 7 March 2011). It is unknown whether dobutamine is excreted in human milk, but as many drugs are excreted, manufacturer advises caution and if mother requires dobutamine treatment, breastfeeding should be discontinued for the duration of the treatment.
