Dobutamine

Dobutamine Brand Name– Dobutrex

What is Dobutamine

Dobutamine is a parenteral direct-acting inotrope indicated for the short-term treatment of patients with cardiac decompensation due to depressed contractility resulting either from organic heart disease or from cardiac surgical procedures.

Experience with dobutamine is limited to 48 hours in controlled trials. The primary activity of dobutamine results from stimulation of the beta-receptors of the heart while producing comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects.

It does not cause the release of endogenous norepinephrine, as does dopamine.

Dobutamine increases the cardiac output to a similar degree as isoproterenol in patients with depressed cardiac function. In contrast to isoproterenol, this increase is usually not accompanied by marked increases in heart rate, and the cardiac stroke volume is usually increased.

Septic shock guidelines recommend dobutamine in patients who show evidence of persistent hypoperfusion despite adequate fluid loading and the use of vasopressors.

Heart failure guidelines suggest inotropic support until definitive therapy or resolution of the acute precipitating problem to maintain systemic perfusion and preserve end-organ performance.

Short-term, continuous IV inotropic support may be reasonable in hospitalized patients presenting with documented severe systolic dysfunction with low blood pressure and significantly depressed cardiac output.

Long-term continuous IV inotropic support may be considered as palliative therapy for symptom control in patients with stage D heart failure refractory to optimal medical and device therapy who are awaiting mechanical circulatory support (MCS) or cardiac transplant or are not eligible for MCS or transplant.

Additionally, beta-agonists, such as dobutamine, may be considered in patients with sinus node dysfunction or second- or third-degree atrioventricular block associated with hemodynamic compromise who are at a low likelihood of coronary ischemia to increase heart rate, improve atrioventricular conduction, increase ventricular rate, and improve symptoms.

Indications

1. cardiac surgery
2. cardiogenic shock
3. heart failure
4. septic shock

For the short-term inotropic treatment of low output states caused by congestive heart failure, cardiogenic shock, septic shock†, or after cardiac surgery

Side Effects

1. anaphylactoid reactions
2. angina
3. arrhythmia exacerbation
4. bronchospasm
5. cardiomyopathy
6. chest pain (unspecified)
7. dyspnea
8. eosinophilia
9. fever
10. headache
11. hypertension
12. hypokalemia
13. hypotension
14. injection site reaction
15. myoclonia
16. nausea
17. palpitations
18. phlebitis
19. premature ventricular contractions (PVCs)
20. pulmonary edema
21. rash
22. sinus tachycardia
23. skin necrosis
24. thrombocytopenia
25. ventricular tachycardia

Monitoring Parameters

• laboratory monitoring not necessary

Contraindications

• acute myocardial infarction
• angina
• atrial fibrillation
• breast-feeding
• cardiac arrhythmias
• corn hypersensitivity
• coronary artery disease
• geriatric
• hypertension
• hypotension
• hypovolemia
• idiopathic hypertrophic subaortic stenosis
• pregnancy
• premature neonates
• renal failure
• sulfite hypersensitivity
• ventricular arrhythmias

Interactions

• Acarbose
• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Aclidinium; Formoterol
• Albiglutide
• Albuterol
• Albuterol; Ipratropium
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Alogliptin; Pioglitazone
• Alpha-blockers
• Alpha-glucosidase Inhibitors
• Ambrisentan
• Amiloride; Hydrochlorothiazide, HCTZ
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amoxapine
• Arformoterol
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Atenolol
• Atenolol; Chlorthalidone
• Atomoxetine
• Azilsartan; Chlorthalidone
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• Ginger, Zingiber officinale
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• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Methyldopa
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Moexipril
• Hydrochlorothiazide, HCTZ; Olmesartan
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Quinapril
• Hydrochlorothiazide, HCTZ; Spironolactone
• Hydrochlorothiazide, HCTZ; Telmisartan
• Hydrochlorothiazide, HCTZ; Triamterene
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• Iloprost
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