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Indications and Dosage
Intravenous
Acute heart failure Adult: For correction of haemodynamic imbalance as present in shock, MI, open heart surgery, renal failure, or cardiac decompensation: Initially, 2-5 mcg/kg/minute, increased gradually by up to 5-10 mcg/kg/minute according to patient's blood pressure, cardiac and urine output. For severe cases, up to 20-50 mcg/kg/minute may be required.
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Reconstitution
Dilute solution (usually 1.6 mg/mL or 3.2 mg/mL) in NaCl 0.9%, glucose 5%, or other suitable diluents.
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Incompatibility
Na bicarbonate, furosemide, thiopental Na, insulin, alteplase, ampicillin, amphotericin B, gentamicin sulfate, cefalothin Na and oxacillin Na.
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Contraindications
Phaeochromocytoma, hyperthyroidism, uncorrected tachyarrhythmias or ventricular fibrillation. Concurrent use with cyclopropane and halogenated hydrocarbon anaesthetics.
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Special Precautions
Patients with CV disease, cardiac arrythmias, occlusive vascular disease (e.g. atherosclerosis, arterial embolism, Raynaud’s disease, cold injury, diabetic endarteritis, Buerger’s disease), active myocardial ischaemia, post-myocardial infarction, electrolyte imbalance (e.g. hypokalaemia, hypomagnesemia). Correct hypovolaemia, hypoxia, hypercapnia, acidosis and electrolyte disturbances prior to initiation of therapy. Concomitant use with MAOIs. Infuse into a large vein to prevent extravasation. Pregnancy and lactation.
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Adverse Reactions
Significant: Arrythmia, extravasation.
Blood and lymphatic system disorders: Azotaemia. Cardiac disorders: Anginal pain, atrial fibrillation, bradycardia, palpitation, ectopic beats, tachycardia, ventricular conduction, widened QRS complex. Gastrointestinal disorders: Nausea, vomiting. Nervous system disorders: Headache. Psychiatric disorders: Anxiety. Respiratory, thoracic and mediastinal disorders: Dyspnoea. Skin and subcutaneous tissue disorders: Piloerection. Vascular disorders: Hypertension, hypotension. Potentially Fatal: Rarely, ventricular arrythmia, gangrene (high dose). |
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IV/Parenteral: C
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Monitoring Parameters
Monitor blood pressure, ECG, heart rate, cardiac output, pulmonary wedge pressure, serum glucose, renal function and urine output.
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Overdosage
Symptoms: Excessive blood pressure elevation, vasoconstriction. Management: Reduce dose or discontinue infusion. If these measures fail, may consider administration of phentolamine mesylate.
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Drug Interactions
Cardiac effects are antagonised by β-adrenergic agents (e.g. propanolol, metoprolol). α-adrenergic blocking agents may antagonise the vasoconstricting effect of high dose dopamine. Prolonged and enhanced effect with MAOIs. Risk of hypotension and bradycardia with phenytoin. May enhance effect of diuretics. Risk of excessive vasoconstriction with ergot alkaloids. May enhance vasopressor effect with TCAs and guanethidine.
Potentially Fatal: May enhance the arrhythmogenic effect with cyclopropane and halogenated hydrocarbon anaesthetics. |
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Lab Interference
May interfere with urine tests for amino acids or catecholamines and tests for detecting uric acid or urobilinogen.
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Action
Description: Dopamine stimulates dopaminergic receptors at lower doses producing renal and mesenteric vasodilation; at higher doses stimulates both dopaminergic and β1-adrenergic receptors producing cardiac stimulation and renal vasodilation; large doses stimulates α-adrenergic receptors.
Onset: Within 5 minutes. Duration: <10 minutes. Pharmacokinetics: Distribution: Widely distributed. Metabolism: Metabolised in the kidney, liver and plasma by monoamine oxidase and COMT to inactive metabolites, homovanillic acid and 3, 4-dihydroxyphenylacetic acid. Approx 25% is metabolised to norepinephrine (active). Excretion: Via urine (as metabolites). Half-life elimination: Approx 2 minutes. |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Dopamine, CID=681, https://pubchem.ncbi.nlm.nih.gov/compound/Dopamine (accessed on Jan. 21, 2020) |
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Storage
Store below 30°C. Protect from light.
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MIMS Class
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ATC Classification
C01CA04 - dopamine ; Belongs to the class of adrenergic and dopaminergic cardiac stimulants excluding glycosides. Used in the treatment of hypotension.
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References
Anon. Dopamine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 19/08/2019. Buckingham R (ed). Dopamine Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com . Accessed 19/08/2019. Dopamine Hydrochloride Injection (West-Ward Pharmaceuticals Corp). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 19/08/2019. Dopamine Hydrochloride Injection, Solution (American Regent, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 22/10/2015. Joint Formulary Committee. Dopamine Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 19/08/2019. McEvoy GK, Snow EK, Miller J et al (eds). Dopamine Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 22/10/2015.
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