dobutamine

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Metabolized by the liver and other tissues.

Half-Life: 2 min.

Time/Action Profile ⬆ ⬇

(inotropic effects)

ROUTE	ONSET	PEAK	DURATION
IV	1–2 min	10 min	brief (min)

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to dobutamine or bisulfites;
Idiopathic hypertrophic subaortic stenosis.

Use Cautiously in:

Hypertension (↑ risk of exaggerated pressor response);
MI;
Atrial fibrillation;
History of ventricular atopic activity (may be exacerbated);
Hypovolemia (correct before administration);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension, premature ventricular contractions, tachycardia, angina, arrhythmias, hypotension, palpitations

GI: nausea, vomiting

Local: phlebitis

Neuro: headache

Resp: shortness of breath

Misc: hypersensitivity reactions, nonanginal chest pain

Interactions ⬆ ⬇

Drug-drug:

Beta blockers may negate the effect of dobutamine.
↑risk of arrhythmias or hypertension with some anesthetics (cyclopropane, halothane), MAO inhibitors, oxytocics, or tricyclic antidepressants.

Route/Dosage ⬆ ⬇

IV (Adults and Children ): 2.5–15 mcg/kg/min; titrate to response (max dose = 40 mcg/kg/min).
IV (Neonates ): 2–15 mcg/kg/min.

Availability ⬆ ⬇

(Generic available)

Solution for injection (requires dilution): 12.5 mg/mL
Premixed infusion: 250 mg/250 mL; 500 mg/250 mL; 1000 mg/250 mL

Assessment ⬆ ⬇

Monitor BP, heart rate, ECG, pulmonary capillary wedge pressure (PCWP), cardiac output, central venous pressure (CVP), and urinary output continuously during the 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.
Palpate peripheral pulses and assess appearance of extremities routinely during dobutamine administration. Notify health care professional if quality of pulse deteriorates or if extremities become cold or mottled.

Lab Test Considerations:

Monitor potassium concentrations during therapy; may cause hypokalemia.
- Monitor electrolytes, BUN, creatinine, and prothrombin time weekly during prolonged therapy.

Toxicity and Overdose:

If overdose occurs, reduction or discontinuation of therapy is the only treatment necessary because of the short duration of dobutamine.

Implementation ⬆ ⬇

IV vasoactive medications are potentially dangerous. Have second practitioner independently check original order, dose calculations, and infusion pump settings. Do not confuse dobutamine with dopamine. If available as floor stock, store in separate areas.
Correct hypovolemia with volume expanders before initiating dobutamine therapy.
- Administer into a large vein and assess administration site frequently. Extravasation may cause pain and inflammation.

IV Administration:

Diluent: Vials must be diluted before use. Dilute 250–1000 mg in 250–500 mL of D5W, 0.9% NaCl, 0.45% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, or LR. Admixed infusions stable for 48 hr at room temperature and 7 days if refrigerated. Premixed infusions are already diluted and ready to use.Concentration: 0.25–5 mg/mL.
Rate: Based on patient's weight (see Route/Dosage section). Administer via infusion pump to ensure precise amount delivered. Titrate to patient response (heart rate, presence of ectopic activity, BP, urine output, CVP, PCWP, cardiac index). Dose should be titrated so heart rate does not increase by >10% of baseline.

Patient/Family Teaching ⬆ ⬇

Explain to patient the dobutamine and the need for frequent monitoring.
Advise patient to inform nurse immediately if chest pain; dyspnea; or numbness, tingling, or burning of extremities occurs.
Instruct patient to notify 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.
Home Care Issues: Instruct caregiver on proper care of IV equipment.
- Instruct caregiver to report signs of worsening HF (shortness of breath, orthopnea, decreased exercise tolerance), abdominal pain, and nausea or vomiting to health care professional promptly.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇