DOBUTAMINE HYDROCHLORIDE

Dobutamine DBL, Dobutrex

Reviewed by NICU and Dept. of Pharmacy
November 2011
Administration Newborn Drug Protocol Index Newborn Services Home Page

 

Dose and Administration

  1. 2-25 micrograms/kg/minute by continuous IV infusion.
  2. Begin at a low dose and titrate by monitoring effects.
  3. Administer via a central line (UVC, Longline, or Surgical CVL).  If no central access available, use a large vein.
  4. Usual dilution 30 mg/kg (2.4 ml/kg) dobutamine to make 50 ml with NS or D5W
    1 ml/hour = 10 micrograms/kg/minute.
Dobutamine (mg) in 50ml IV solution = 3 x weight (kg) x dose (micrograms/kg/min)
                       IV rate (ml/hr)

Maximum concentration = 5 mg/mL

Indication

  1. Blood pressure support in infants with shock and hypotension.

Contraindications and Precautions

  1. Hypersensitivity to sympathomimetic amines and sodium metabisulfite.
  2. Hypovolaemia should be corrected prior to commencing the drug.
  3. Uncorrected tachyarrhythmia.
  4. Caution in infants with hypertension, LV outflow tract obstruction.

Clinical Pharmacology

Dobutamine is a synthetic catecholamine with primarily beta 1 adrenergic activity. It is an inotropic vasopressor. It increases myocardial contractility, cardiac index, oxygen delivery and oxygen consumption. It decreases systemic and pulmonary vascular resistance (adults).

The drug must be administered by continuous IV infusion because of rapid metabolism of the drug. It is metabolised in the liver to an inactive compound. The onset of action is 1-2 minutes after IV administration with the peak effect occurring in 10 minutes. The half-life of its drug effect is two minutes.

Possible Adverse Effects

  1. Venous irritation, soft tissue injury at site of IV infusion.
  2. May cause hypotension if patient is hypovolaemic.
  3. Tachycardia at high dosage.
  4. Arrhythmias, hypertension especially systolic pressure and cutaneous vasodilatation.

Special Considerations

  1. Volume loading is recommended before commencing dobutamine infusion.
  2. Renal dysfunction: no dosage adjustment necessary.
  3. Clinical experience with dobutamine in neonates is limited. Whether dobutamine has any consistent advantages over dopamine in the treatment of a neonate with myocardial dysfunction remains to be established.
  4. Beta blockers may antagonise dobutamine effect.
  5. General anaesthetics: greater incidence of ventricular arrhythmias.
  6. Dobutamine should not be used with agents containing sodium bisulfite.