dopamine

Small doses (0.5–3 mcg/kg/min) stimulate dopaminergic receptors, producing renal vasodilation.
Larger doses (2–10 mcg/kg/min) stimulate dopaminergic and beta₁-adrenergic receptors, producing cardiac stimulation and renal vasodilation.
Doses greater than 10 mcg/kg/min stimulate alpha-adrenergic receptors and may cause renal vasoconstriction.

Therapeutic effects:

Increased cardiac output, increased BP, and improved renal blood flow.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Widely distributed but does not cross the blood-brain barrier.

Metabolism/Excretion: Metabolized in liver, kidneys, and plasma.

Half-Life: 2 min.

Time/Action Profile ⬆ ⬇

(hemodynamic effects)

ROUTE	ONSET	PEAK	DURATION
IV	1–2 min	up to 10 min	<10 min

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Tachyarrhythmias;
Pheochromocytoma;
Hypersensitivity to bisulfites (some products).

Use Cautiously in:

Hypovolemia;
MI;
Occlusive vascular diseases;
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Geri: Older adults may be more susceptible to adverse effects.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias, hypotension, angina, palpitations, vasoconstriction

Derm: piloerection

EENT: mydriasis (high dose)

GI: nausea, vomiting

Local: irritation at IV site

Neuro: headache

Resp: dyspnea

Interactions ⬆ ⬇

Drug-drug:

Use with MAO inhibitors, ergot alkaloids (ergotamine), doxapram, or some antidepressants results in severe hypertension.
Use with IV phenytoin may cause hypotension and bradycardia.
Use with general anesthetics may result in arrhythmias.
Beta blockers may antagonize cardiac effects.

Route/Dosage ⬆ ⬇

IV (Adults ): Dopaminergic (renal vasodilation) effects: 1–5 mcg/kg/min continuous infusion. Beta-adrenergic (cardiac stimulation) effects: 5–15 mcg/kg/min continuous infusion. Alpha-adrenergic (increased peripheral vascular resistance) effects: >15 mcg/kg/min continuous infusion; infusion rate may be ↑ as needed.
IV (Children and Infants): 1–20 mcg/kg/min continuous infusion, depending on desired response (1–5 mcg/kg/min has been used to improve renal blood flow).
IV (Neonates ): 1–20 mcg/kg/min continuous infusion.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 40 mg/mL
Premixed infusion: 200 mg/250 mL; 400 mg/250 mL; 400 mg/500 mL; 800 mg/250 mL; 800 mg/500 mL

Assessment ⬆ ⬇

Monitor BP, heart rate, pulse pressure, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, central venous pressure (CVP), and urinary output continuously during administration. Report significant changes in vital signs or arrhythmias. Consult physician for parameters for pulse, BP, or ECG changes for adjusting dose or discontinuing medication.
Monitor urine output frequently throughout administration. Report decreases in urine output promptly.
Palpate peripheral pulses and assess appearance of extremities routinely during dopamine administration. Notify physician if quality of pulse deteriorates or if extremities become cold or mottled.
If hypotension occurs, administration rate should be increased. If hypotension continues, more potent vasoconstrictors (norepinephrine) may be administered.

Toxicity and Overdose:

If excessive hypertension occurs, rate of infusion should be decreased or temporarily discontinued until BP is decreased.

Implementation ⬆ ⬇

IV vasoactive medications are potentially dangerous. Have second practitioner independently check original order, dose calculations, and infusion pump settings. Do not confuse dopamine with dobutamine. If both are available as floor stock, store in separate areas.
Correct hypovolemia with volume expanders before initiating dopamine therapy.
- Extravasation may cause severe irritation, necrosis, and sloughing of tissue. Administer into a large vein and assess administration site frequently. If extravasation occurs, affected area should be infiltrated liberally with 10–15 mL of 0.9% NaCl containing 5–10 mg of phentolamine. For pediatric patients, use 1 mL of phentolamine dilution to infiltrate (do not exceed 5 mg total). Infiltration within 12 hr of extravasation produces immediate hyperemic changes.

IV Administration:

Diluent: Dopamine vials must be diluted before use. Dilute 200–800 mg of dopamine in 250–500 mL of 0.9% NaCl, D5W, D5/LR, D5/0.45% NaCl, D5/0.9% NaCl, or LR. Admixed solution is stable for 24 hr. Discard solutions that are cloudy, discolored, or contain a precipitate. Premixed infusions are already diluted and ready to use.Concentration: 0.8–3.2 mg/mL.
Rate: Based on patient's weight (see Route/Dosage section). Infusion must be administered via infusion pump to ensure precise amount delivered. Titrate to response (BP, heart rate, urine output, peripheral perfusion, presence of ectopic activity, PCWP, CVP, cardiac index). Decrease rate gradually when discontinuing to prevent marked decreases in BP.

Patient/Family Teaching ⬆ ⬇

Explain purpose of dopamine to patient and the need for frequent monitoring.
Advise patient to inform nurse immediately if chest pain; dyspnea; numbness, tingling, or burning of extremities occurs.
Instruct patient to inform nurse immediately of pain or discomfort at the site of administration.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇