Adult Dosing
Adjunct therapy of shock
- 1-50 mcg/kg/min IV; increase by 1-4 mcg/kg/min q10-30 min to desired effect
- Max: 20-50 mcg/kg/min
Ricin poisoning [Non-FDA Approved]
- 2.5-20 mcg/kg/min IV. In extreme case can go up to maximum of 50 mcg/kg/min
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
Supportive therapy in Pulmonary embolism [Non-FDA Approved]
- Intermediate dose: 5-15 mcg/kg/min IV; increases heart rate, cardiac contractility, cardiac output, and to a lesser extent, renal blood flow
- High dose: >20 mcg/kg/min IV; alpha-adrenergic effects are prominent; decreases renal perfusion
- Max: 20-50 mcg/kg/min IV
Ricin poisoning [Non-FDA Approved]
- 2.5-20 mcg/kg/min IV. In extreme case can go up to maximum of 50 mcg/kg/min
Adjunct therapy of shock in Calcium Channel Blocker Overdose [Non-FDA Approved]
- 1-5 mcg/kg/min IV, increase to 5-20 mcg/kg/min, no more than 50 mcg/kg/min IV. Titrate to desired response
[Outline]
- Dopamine may cause peripheral ischemia in patients w/ history of occlusive vascular disease [US black box warning]
- If ischemia occurs, prevent sloughing and necrosis in ischemic areas by infiltrating areas as soon as possible w/ 5-10 mg of phentolamine (adrenergic blocking agent) in 10-15 mL saline solution [US black box warning]
- A syringe with a fine hypodermic needle should be used and the solution liberally infiltrated throughout the ischemic area [US black box warning]
- Sympathetic blockage with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours. Therefore, phentolamine should be given as soon as possible after the extravasation is noted [US black box warning]
- Patients treated with monoamine oxidase (MAO) inhibitors prior to the administration of dopamine hydrochloride will require substantially reduced dosage. Administer reduced dosage in patients receiving MAO inhibitors prior to the administration of dopamine
- This product contains sodium bisulfite which is associated with allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in susceptible individuals. Asthmatic individuals are more susceptible to such events
- Correct hypovolemia with either whole blood or plasma prior to treatment with dopamine
- Avoid adding any alkalinizing substance as dopamine will be inactivated in alkaline solution
- Solutions containing dextrose should not be administered through the same administration set as blood, as this may result in pseudoagglutination or hemolysis
- The intravenous administration of solutions may cause fluid overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema
- Correct hypoxia, hypercapnia, acidosis prior to therapy if possible, with either whole blood, plasma, or plasma expanders as it may reduce the effectiveness and/or increase the incidence of adverse effects of dopamine. Monitoring of central venous pressure or left ventricular filling pressure may be helpful in detecting and treating hypovolemia
- Decrease rate of infusion and carefully observe patient for further evidence of predominant vasoconstrictor activity on observing disproportionate increase in diastolic blood pressure and a marked decrease in pulse pressure
- At lower infusion rates, if hypotension occurs, the infusion rate should be rapidly increased until adequate blood pressure is obtained. If hypotension persists, dopamine should be discontinued and a more potent vasoconstrictor agent such as norepinephrine should be administered
- Closely monitor patients with a history of occlusive vascular disease (for example, atherosclerosis, arterial embolism, Raynaud’s disease, cold injury, diabetic endarteritis and Buerger’s disease) for any changes in color or temperature of the skin in the extremities
- Prefer large veins of the antecubital fossa to veins in the dorsum of the hand or ankle. Use less suitable infusion sites only if the patient’s condition requires immediate attention. Switch to more suitable sites as rapidly as possible. Continuously monitor the infusion site for free flow
- Gradually decrease the dose of dopamine while considering expansion with I.V. fluids and discontinuing therapy with this drug
- Closely monitor the following indices - urine flow, cardiac output and blood pressure during dopamine hydrochloride infusion as in the case of any adrenergic agent
- Closely monitor changes in fluid balance, electrolyte concentrations and acid base balance during prolonged parenteral therapy or whenever the condition of the patient warrants such evaluation
Caution: Use cautiously in
- Hypersensitivity to sulfites
- Diabetic endarteritis
- Use with MAO-inhibitors
- Occlusive vascular disease
- Raynaud phenomenon
- Ventricular arrhyhtmias
- Decreased blood pressure
- Hypotension
Pregnancy Category:C
Breastfeeding: Literature on the use of dopamine during breastfeeding is not available. Dopamine in milk is unlikely to affect the infant. IV dopamine infusion decreases milk production. Serum prolactin is decreased in non nursing women on use of dopamine but information is unavailable on its effect on milk production in nursing mothers. This information is (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 02 August 2013). Manufacturer advises caution.
