dobutamine hydrochloride


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dobutamine hydrochloride

Pharmacologic class: Sympathomimetic, adrenergic

Therapeutic class: Inotropic

Pregnancy risk category B

Action

Stimulates beta1-adrenergic receptors of heart, causing a positive inotropic effect that increases myocardial contractility and stroke volume. Also reduces peripheral vascular resistance, decreases ventricular filling pressure, and promotes atrioventricular conduction.

Availability

Injection: 12.5 mg/ml in 20-ml vials

Indications and dosages

Short-term treatment of cardiac decompensation caused by depressed contractility (such as during refractory heart failure); adjunct in cardiac surgery

Adults: 2.5 to 10 mcg/kg/minute I.V. as a continuous infusion, adjusted to hemodynamic response

Dosage adjustment

• Elderly patients

Off-label uses

• Adjunct in myocardial infarction (MI) and septic shock
• Diagnosis of coronary artery disease (echocardiography stress test, ventriculography, computed tomography)

Contraindications

• Hypersensitivity to drug
• Idiopathic hypertrophic subaortic stenosis

Precautions

Use cautiously in:
• hypertension, MI, atrial fibrillation, hypovolemia
• pregnant or breastfeeding patients
• children.

Administration

• As needed, correct hypovolemia before starting therapy by giving volume expanders, as prescribed.
• Use infusion pump or microdrip I.V. infusion set.
• Dilute with dextrose 5% in water or normal saline solution to at least 50 ml of solution. Know that drug is incompatible with alkaline solutions, such as sodium bicarbonate injection.

Adverse reactions

CNS: headache

CV: hypertension, hypotension, tachycardia, premature ventricular contractions, angina, palpitations, nonspecific chest pain, phlebitis

GI: nausea, vomiting

Metabolic: hypokalemia

Respiratory: dyspnea, asthma attacks

Skin: extravasation with tissue necrosis

Other: hypersensitivity reactions including anaphylaxis

Interactions

Drug-drug.Beta-adrenergic blockers: increased alpha-adrenergic effects

Bretylium: potentiation of vasopressor activity

Cyclopropane, halothane: serious arrhythmias

Guanethidine: decreased hypotensive effects

Thyroid hormone: increased cardiovascular effects

Tricyclic antidepressants: potentiation of cardiovascular and vasopressor effects

Drug-herbs.Rue: increased inotropic potential

Patient monitoring

• Monitor ECG and blood pressure continuously during administration.
• Monitor cardiac output, pulmonary capillary wedge pressure, and central venous pressure.
• Monitor fluid intake and output and watch for signs and symptoms of worsening heart failure.

Assess electrolyte levels. Stay especially alert for hypokalemia.

Patient teaching

• Instruct patient to report anginal pain, headache, leg cramps, and shortness of breath.
• Explain need for close observation and monitoring.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs mentioned above.

DOBUTamine hydrochloride

[dōbyo̅o̅′təmēn]
a beta-adrenergic stimulating agent, acting primarily on beta-1 receptors.
indications It is prescribed to increase cardiac output in severe chronic congestive heart failure and to provide adjunct in cardiac surgery.
contraindications Idiopathic hypertrophic subaortic stenosis or known hypersensitivity to this drug prohibits its use. It is not recommended for use in pregnancy.
adverse effects Among the most serious adverse reactions are cardiovascular effects, including tachycardia, hypertension, arrhythmias, and precipitation of angina. Nausea, vomiting, and headache may also occur.

dobutamine hydrochloride

(dō-būt′ă-mēn)
A synthetic beta-agonist whose primary effect is to increase cardiac contractility, with little effect on systemic vascular resistance. It produces less tachycardia than dopamine and has no effect on renal blood flow. It is of use in congestive heart failure and cardiogenic shock.