Dopamine

 


Other Names

Intropin


Classification

Sympathomimetic


Action

  1. •Dopaminergic effects in the dose range of 0.5 - 5 mcg/kg/min

  2. •β1 effects in the dose range of 5 - 10 mcg/kg/min

  3. •α effects in the dose range of 10 - 20 mcg/kg/min


Indications

  1. •To correct hemodynamic imbalances in shock-like status i.e. MI, endotoxic septicemia

  2. •Normovolemic, hypotensive bradycardia or hypovolemic hypotensive bradycardia refractory to fluid replacement

  3. •To increase renal blood flow and urine output (Dopaminergic effect) – although this is becoming more doubted and losing favour


Contraindications

  1. •Hypersensitivity to the medication

  2. •Patients with pheochromocytoma

  3. •Patients with uncorrected tachyarrhythmias


Precautions

Caution in patients with history of occlusive vascular disease


Adverse Reactions

  1. •Ectopic beats, tachycardia, anginal pain, palpitation (Antidote: beta-adrenergic blocking agents)

  2. •Vasoconstriction (Antidote: alpha-adrenergic blocking agents)

  3. •Hypotension, dyspnea, nausea, vomiting and headache

  4. •Less frequently: cardiac conduction abnormalities, widened QRS complex, bradycardia, hypertension, piloerection

  5. •Ventricular arrhythmias

  6. •Overdose results in hypertension, tachycardia +/- ectopy, and reduced urine output


Interactions/Compatibility/Stability

  1. •Stable in NS, D5W, Ringer’s Lactate for 48 hours at room temperature

  2. •Compatible with heparin, lidocaine HCl, neutral cephalothin sodium, oxacillin sodium, gentamicin sulfate, potassium chloride, calcium chloride in D5W

  3. •No physical incompatibility with methylprednisolone or hydrocortisone sodium succinate

  4. •Inactivated in alkaline media (i.e. sodium bicarbarbonate solutions)


Special Considerations

  1. •Alkalotic states and hypovolemia should be corrected prior to the use of Dopamine

  2. •Extravasation may cause peripheral gangrene, necrosis and sloughing of surrounding tissue. (Antidote = Phentolamine 5 - 10 mg diluted with 10 - 15 ml NS)

  3. •Infusion devices are preferred for infusions, but are not always practical in the prehospital setting


Dosages

Preparations:

  1. •200 mg/5 ml vial (40 mg/ml) mixed with 250 ml NS yields 800 µg/ml

  2. •400 mg/5 ml vial (80 mg/ml) mixed with 250 ml NS yields 1600 µg/ml

Adult:

  1. •IV infusion @ 2 - 5 mcg/kg/min, increase by 2.5 - 5 mcg/kg/min q 3-10 minutes PRN (to desired effect)

Pediatric:

Same as adult (IV or IO) increase by 1 mcg/kg/min


Kinetics

Onset           < 5 minutes

Peak             < 10 minutes

Duration      < 10 minutes




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