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Pharmacologic class: Catecholamine, adrenergic
Therapeutic class: Inotropic, vasopressor
Pregnancy risk category C
FDA Box Warning
• Dilute full-strength injection before administering.
• If extravasation occurs, infiltrate area promptly with 10 to 15 ml of saline solution containing 5 to 10 mg phentolamine to prevent sloughing and necrosis. Use syringe with fine hypodermic needle, and infiltrate solution liberally throughout area. Give phentolamine as soon as possible; its sympathetic blockade causes immediate local hyperemic changes if area is infiltrated within 12 hours.
Causes norepinephrine release (mainly on dopaminergic receptors), leading to vasodilation of renal and mesenteric arteries. Also exerts inotropic effects on heart, which increases the heart rate, blood flow, myocardial contractility, and stroke volume.
Injection for dilution: 40 mg/ml, 80 mg/ml, 160 mg/ml
Premixed injection: 0.8 mg/ml, 1.6 mg/ml, 3.2 mg/ml in 250 ml and 500 ml of dextrose 5% in water
Indications and dosages
➣ Shock; hemodynamic imbalance; hypotension; heart failure
Adults and children: 2 to 5 mcg/kg/minute by I.V. infusion. Titrate dosage to desired response; may increase infusion by 1 to 4 mcg/kg/minute at 10- to 30-minute intervals. Maximum dosage is 50 mcg/kg/minute.
• Hypersensitivity to drug or bisulfites
• Tachyarrhythmias, ventricular fibrillation
Use cautiously in:
• hypovolemia, myocardial infarction, occlusive vascular disease, diabetic endarteritis, atrial embolism
• concurrent MAO inhibitor use
• pregnant or breastfeeding patients
• Give I.V. infusion using metered pump or other device that controls flow.
• Add 200 to 400 mg of dopamine to 250 to 500 ml of normal saline solution, 5% dextrose injection, 5% dextrose and half-normal saline solution, or 5% dextrose in lactated Ringer's solution.
• Infuse into large (preferably central) vein to minimize extravasation.
☞ Don't give concurrently with MAO inhibitors. Reduce dosage if patient has received MAO inhibitor recently.
CV: palpitations, hypotension, angina, ECG changes, tachycardia, vasoconstriction, arrhythmias
GI: nausea, vomiting
Metabolic: azotemia, hyperglycemia
Respiratory: dyspnea, asthma attacks
Other: irritation at injection site, gangrene of extremities (with high doses for prolonged periods or in occlusive vascular disease)
Drug-drug. Alpha- or beta-adrenergic blockers: antagonism of dopamine effects
Ergot alkaloids: extreme blood pressure increase
Guanethidine: decreased cardiostimulatory effects
Inhalation anesthetics: increased risk of hypertension, arrhythmias
MAO inhibitors: hypertensive crisis
Oxytocics: severe, persistent hypotension
Phenytoin: seizures, severe hypotension, bradycardia
Tricyclic antidepressants: decreased pressor response
Drug-diagnostic tests. Glucose, nitrogenous compounds, urine catecholamines: increased levels
• Monitor blood pressure, pulse, urinary output, and pulmonary artery wedge pressure during infusion.
☞ Inspect I.V. site regularly for irritation. Avoid extravasation.
☞ Monitor color and temperature of extremities.
☞ Never stop infusion abruptly, because this may cause severe hypotension. Instead, taper gradually.
• Explain the need for close observation during infusion.
• Instruct patient to report adverse reactions and I.V. site discomfort.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.