dobutamine

Therapeutic Classification: inotropics

Pharmacologic Classification: adrenergics

High Alert

Short-term management of HF caused by depressed contractility from organic heart disease or surgical procedures.

Stimulates beta₁(myocardial)-adrenergic receptors to improve cardiac contractility.

Therapeutic effects:

Increased cardiac output.

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

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

Half-Life: 2 min.

( inotropic effects)

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

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.

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

GI: nausea, vomiting.

Local: phlebitis

Neuro: headache

Resp: dyspnea

Misc: hypersensitivity reactions, nonanginal chest pain

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.

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.

(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

Monitor BP, HR, 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 HR, 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 provider if quality of pulse deteriorates or if extremities become cold or mottled.

Lab Test Considerations:

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

High Alert: 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.

IV Administration:

Vesicant: Dobutamine is a vesicant. Administer into a large vein. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient’s extremity and apply dry warm compresses. Initiate phentolamine antidote for refractory cases in addition to supportive management. For phentolamine, dilute 5–10 mg in 10 mL of 0.9% NaCl and administer SUBQ into extravasation site as soon as possible after extravasation; if IV catheter remains in place, administer initial dose IV through the infiltrated catheter. May repeat in 60 min if patient remains symptomatic. Nitroglycerin 2% topical ointment (1-inch strip applied to site of ischemia to cover affected area; may repeat every 8 hr as necessary) or terbutaline (dilute 1 mg in 10 mL of 0.9% NaCl and administer SUBQ into extravasation site; may repeat in 15 min if necessary) may be used as alternatives to phentolamine.
Continuous Infusion: 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, LR, or D5/LR. Admixed infusions stable for 24 hr at room temperature and 48 hr if refrigerated. Premixed infusions are already diluted and ready to use. A pink color may occur due to oxidation of the drug; there is no significant loss of potency over 24 hr. 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 (HR, presence of ectopic activity, BP, urine output, CVP, PCWP, cardiac index). Dose should be titrated so HR does not increase by >10% of baseline.
Y-Site Compatibility:
- alemtuzumab
- alprostadil
- amikacin
- aminocaproic acid
- anidulafungin
- argatroban
- arsenic trioxide
- ascorbic acid
- atracurium
- atropine
- azithromycin
- aztreonam
- benztropine
- bleomycin
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- cangrelor
- carboplatin
- caspofungin
- ceftolozane/tazobactam
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- cladribine
- clevidipine
- clindamycin
- cyanocoblamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- daptomycin
- daunorubicin
- dexmedetomidine
- digoxin
- diltiazem
- dimenhydrinate
- diphenhydramine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- eravacycline
- erythromycin
- esmolol
- etoposide phosphate
- famotidine
- fentanyl
- fluconazole
- fludarabine
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- hetastarch
- hydromorphone
- hydroxyzine
- idarubicin
- ifosfamide
- insulin aspart
- irinotecan
- isavuconazonium
- isoproterenol
- ketamine
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- meperidine
- mesna
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- milrinone
- mitoxantrone
- morphine
- moxifloxacin
- multivitamins
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- norepinephrine
- octreotide
- ondansetron
- oritavancin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- papaverine
- pentamidine
- phentolamine
- phenylephrine
- plazomicin
- posaconazole
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propranolol
- protamine
- pyridoxine
- remifentanil
- rituximab
- rocuronium
- sodium acetate
- succinylcholine
- sufentanil
- sulbactam/durlobactam
- tacrolimus
- televancin
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- acyclovir
- alteplase
- aminophylline
- amphotericin B deoxycholate
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- azathioprine
- bivalirudin
- carmustine
- cefazolin
- cefotaxime
- cefotetan
- cefoxitin
- ceftriaxone
- cefuroxime
- chloramphenicol
- dacarbazine
- dantrolene
- dexamethasone
- dexrazoxane
- diazoxide
- ertapenem
- fluorouracil
- folic acid
- foscarnet
- fosphenytoin
- ganciclovir
- gemtuzumab ozogamicin
- hydrocortisone
- hydroxocobalamin
- ketorolac
- meropenem
- meropenem/vaborbactam
- methotrexate
- micafungin
- mitomycin
- oxacillin
- pantoprazole
- pemetrexed
- penicillin G
- pentobarbital
- phenobarbital
- phenytoin
- piperacillin/tazobactam
- sodium bicarbonate
- tedizolid
- trimethoprim/sulfamethoxazole

Explain the purpose and side effects of 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 IV administration.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Home Care Issues: Instruct caregiver on proper care of IV equipment.
- Instruct caregiver to report signs of worsening HF (shortness of breath, orthopnea, ↓ exercise tolerance), abdominal pain, and nausea or vomiting to health care provider promptly.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Increase in cardiac output.
- Improved hemodynamic parameters.
- Increased urine output.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆