May 29, 2017
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Dopamine

Medical and Pharmacy Editor:

Brand Name: Intropin

Generic Name: dopamine

Drug Class: Inotropic Agents

What Is Dopamine and How Does It Work?

Dopamine is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, renal failure, and chronic cardiac decompensation as in congestive failure.

Patients most likely to respond adequately to dodpamine are those in whom physiological parameters, such as urine flow, myocardial function, and blood pressure, have not undergone profound deterioration. Multi-clinic trials indicate that the shorter the time interval between onset of signs and symptoms and initiation of therapy with volume correction and dopamine, the better the prognosis. Where appropriate, blood volume restoration with a suitable plasma expander or whole blood should be accomplished or completed prior to administration of dopamine.

Dopamine is available under the following different brand names: Intropin.

Dosages of Dopamine:

Adult and Pediatric Dosage Forms and Strengths

Infusion solution, in D5W

  • 80 mg/100mL
  • 160 mg/100mL
  • 320 mg/100mL

Injectable solution

  • 40 mg/100mL
  • 80 mg/100mL
  • 160 mg/100mL

Dosage Considerations – Should be Given as Follows:

Hemodynamic Conditions

Adult

  • Treatment of hypotension, low cardiac output, poor perfusion of vital organs; used to increase mean arterial pressure in septic shock patients who remain hypotensive after adequate volume expansion
  • 1-5 mcg/kg/min intravenously (IV) (low dose): May increase urine output and renal blood flow
  • 5-15 mcg/kg/min IV (medium dose): May increase renal blood flow, cardiac output, heart rate, and cardiac contractitlity
  • 20-50 mcg/kg/min IV (high dose): May increase blood pressure and stimulate vasoconstriction; may not have a beneficial effect in blood pressure; may increase risk of tachyarrhythmias
  • May increase infusion by 1-4 mcg/kg/min at 10-30 min intervals until optimum response obtained
  • Titrate to desired response

Pediatric

  • Treatment of hypotension
  • 1-5 mcg/kg/min intravenously (IV), increased to 5-20 mcg/kg/min; not to exceed 50 mcg/kg/min
  • Titrate to desired response

Dosing Considerations

  • Strong beta1-adrenergic, alpha-adrenergic, and dopaminergic effects are based on dosing rate
  • Beta1 effects: 2-10 mcg/kg/min
  • Alpha effects: greater than 10 mcg/kg/min
  • Dopaminergic effects: 0.5-2 mcg/kg/min

Post-MI Therapy in Left Ventricular Dysfunction

  • May be initiated more than 12 hours after myocardial infarction (MI)
  • 20 mg orally every 12 hours initially, 12 hours after MI, then increased to 40 mg orally every 12 hours within 7 days
  • Maintenance: Titrated to 160 mg orally every 12 hours as tolerated

Administration

  • Although food may decrease absorption (by 40%), manufacturer states drug may be administered without regard to meals
  • Drug may also be given in combination with hydrochlorothiazide (Diovan HCT) or amlodipine (Exforge)

Dose Modification

Renal Impairment

  • CrCl 30 mL/min or greater: No dose adjustment necessary in adults
  • CrCl less than 30 mL/min: Use with caution in adults; not studied in children

Hepatic Impairment

  • Mild to moderate liver impairment: No adjustment necessary; use with caution in liver disease
  • Severe liver impairment: Not studied

Dosing Considerations

  • Generally, adjust dosage monthly (maximal reduction of blood pressure attained after 4 weeks); adjust more aggressively in high-risk patients and patients with comorbidities
Medically Reviewed by a Doctor on 4/14/2017



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