dopamine

High Alert

Adjunct to standard measures to improve:
- BP,
- Cardiac output,
- Urine output in treatment of shock unresponsive to fluid replacement.
Increase renal perfusion (low doses).

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.

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

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.

Action ⬆ ⬇

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.

Classifications ⬆ ⬇

Therapeutic Classification: inotropics, vasopressors

Pharmacologic Classification: adrenergics

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

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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Indications ⬇