Drug Detail:Dopamine (injection) (Dopamine (injection) [ doe-pa-meen ])
Drug Class: Catecholamines Inotropic agents Vasopressors
Usual Adult Dose for Cardiothoracic Surgery
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients should undergo circulatory volume restoration before starting this drug.
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Adult Dose for Congestive Heart Failure
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients should undergo circulatory volume restoration before starting this drug.
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Adult Dose for Myocardial Infarction
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients should undergo circulatory volume restoration before starting this drug.
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Adult Dose for Renal Failure
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients should undergo circulatory volume restoration before starting this drug.
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Adult Dose for Shock
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients should undergo circulatory volume restoration before starting this drug.
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Adult Dose for Septicemia
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients should undergo circulatory volume restoration before starting this drug.
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Pediatric Dose for Cardiothoracic Surgery
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
- Patients should undergo circulatory volume restoration before starting this drug.
- Maintenance doses should be titrated to desired response.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Pediatric Dose for Congestive Heart Failure
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
- Patients should undergo circulatory volume restoration before starting this drug.
- Maintenance doses should be titrated to desired response.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Pediatric Dose for Myocardial Infarction
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
- Patients should undergo circulatory volume restoration before starting this drug.
- Maintenance doses should be titrated to desired response.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Pediatric Dose for Renal Failure
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
- Patients should undergo circulatory volume restoration before starting this drug.
- Maintenance doses should be titrated to desired response.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Pediatric Dose for Shock
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
- Patients should undergo circulatory volume restoration before starting this drug.
- Maintenance doses should be titrated to desired response.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Usual Pediatric Dose for Septicemia
Initial dose: 2 to 10 mcg/kg/min IV by continuous infusion
Maintenance dose: 2 to 50 mcg/kg/min IV by continuous infusion
Comments:
- Patients with advanced circulatory decompression states have been given rates greater than 50 mcg/kg/min.
- Urinary flow should be monitored in patients given rates over 50 mcg/kg/min.
- Patients should undergo circulatory volume restoration before starting this drug.
- Maintenance doses should be titrated to desired response.
Use: Correction of hemodynamic imbalances present in shock due to myocardial infection, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation/refractory congestive heart failure
Renal Dose Adjustments
Data not available
Liver Dose Adjustments
Data not available
Dose Adjustments
Initial dose adjustments:
- MAO inhibitor use within the last 2 to 3 weeks: Patients should be given an initial dose that is 1/10 or less of the initial dose.
Adjustments during treatment:
- Compromised extremity circulation: Healthcare providers should weigh the benefits of continued treatment versus discontinuation. If providers continue treatment, a lower rate of infusion should be considered.
- Hypotension: The infusion rate should be increased in patients receiving low infusion rates. If hypotension persists, treatment should be discontinued and a more potent vasoconstriction agent should be used (e.g., norepinephrine).
- Increased ectopic beats: If possible, the dose should be decreased.
Cessation of treatment: Some patients may require gradual dose reductions and IV blood expansion during discontinuation.
Precautions
US BOXED WARNINGS:
ANTIDOTE FOR PERIPHERAL ISCHEMIA:
- To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible with 10 to 15 mL of saline solution containing 5 to 10 mL of phentolamine mesylate, an adrenergic blocking agent.
- A syringe with a fine hypodermic needle should be used, and the solution liberally infiltrated throughout the ischemic area.
- Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infiltrated within 12 hours.
- Therefore, phentolamine should be given as soon as possible after the extravasation is noted.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Administration advice:
- If possible, this drug should be given into the large veins of the antecubital fossa (preferred site), with dorsum of the hand or ankle as less preferred sites. Umbilical arterial catheter administration should be avoided.
- This drug should be administered via infusion pump, especially a volumetric pump.
- Injection solutions should be clear, colorless to very slightly yellow, and free of particulate matter.
Storage requirements:
- Injection solutions: Protect from freezing; this drug should be kept in the overwrap to protect from light until ready to use.
Reconstitution/preparation techniques:
- Concentrated solutions should be properly diluted prior to administration. The manufacturer package information should be consulted for further instructions.
- Alkaline solutions (e.g., sodium bicarbonate) should not be added to this drug.
IV compatibility:
- This drug should not be given in the same solution with other drugs.
- Blood should not be given concomitantly through the same IV set.
General:
- After the initial infusion, the infusion site should be monitored for free flow.
- Patients who do not have fluid expansion restrictions may use a less concentrated (e.g., 800 mcg/mL) solution; patients with fluid retention and/or when a slower infusion rate is needed may use more concentrated solutions (e.g., 1600 mcg/mL or 3200 mcg/mL).
- Dosing should be patient-specific and based upon desired hemodynamic and/or renal response.
Monitoring:
- Cardiovascular: Blood pressure/arterial blood pressure, ECG, cardiac status, peripheral perfusion, cardiac output (when possible)
- Renal: Urine flow/output, renal function tests
- Respiratory: Pulmonary wedge pressure (when possible)
Patient advice:
- Patients should be instructed to immediately report any changes to extremities (e.g., loss of sensation, discoloration, skin cool/cold to the touch).
Frequently asked questions
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