Home Drug Guide Dobutamine Hydrochloride

Drug Guide

Generic Name

Dobutamine Hydrochloride

Brand Names Dobutrex, Dobutamine Hydrochloride In Dextrose 5% In Plastic Container, Dobutamine Hydrochloride In Dextrose 5%

Classification

Therapeutic: Inotropic agent, cardiovascular agent

Pharmacological: Beta-1 adrenergic agonist

FDA Approved Indications

Short-term management of acute heart failure and cardiogenic shock to improve cardiac output

Mechanism of Action

Dobutamine is a synthetic catecholamine that primarily stimulates beta-1 adrenergic receptors, leading to increased myocardial contractility and cardiac output. It also has some beta-2 and alpha-adrenergic activity, which can affect vascular resistance.

Dosage and Administration

Adult: Typically 2.5 to 20 mcg/kg/min IV infusion, titrated to response. Start at 2.5 mcg/kg/min and increase every 10-15 minutes as needed.

Pediatric: Dosage varies; typically 0.2 to 10 mcg/kg/min IV infusion, titrated based on response.

Geriatric: Use with caution; start at lower doses due to increased sensitivity and comorbidities.

Renal Impairment: Adjust based on patient response; no specific guidelines, but careful monitoring is essential.

Hepatic Impairment: No specific dosing guidelines, but consider decreased clearance.

Pharmacokinetics

Absorption: Administered intravenously, so immediate bioavailability.

Distribution: Widely distributed in body tissues.

Metabolism: Primarily hepatic metabolism via conjugation; minimal metabolism via COMT.

Excretion: Renally excreted mainly as conjugates.

Half Life: 2 minutes (short, requires continuous infusion)

Contraindications

Hypersensitivity to dobutamine or component of formulation
Ventricular arrhythmias (except when treating shock)

Precautions

Use cautiously in patients with severe hypertension, tachyarrhythmias, or ischemic heart disease. Monitor for arrhythmias, ischemia, and worsening hypertension. Use with caution in pregnant women; data limited.

Adverse Reactions - Common

Tachycardia (Common)
Arrhythmias (Common)
Hypertension or hypotension (Common)

Adverse Reactions - Serious

Significant arrhythmias including ventricular tachycardia (Serious)
Myocardial ischemia or infarction (Serious)
Anaphylactoid reactions (Rare)

Drug-Drug Interactions

Beta-blockers may reduce effectiveness.
Other inotropes or vasopressors may enhance cardiovascular effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, ECG for arrhythmias, and signs of ischemia.

Diagnoses:

Risk for decreased cardiac output
Risk for arrhythmias

Implementation: Administer via continuous IV infusion, titrate according to response; monitor vital signs closely.

Evaluation: Assess for improvement in cardiac output, blood pressure, and symptom relief.

Patient/Family Teaching

Inform about possible side effects like rapid heartbeat, irregular rhythm.
Notify healthcare provider if chest pain, dizziness, or palpitations occur.

Special Considerations

Black Box Warnings:

None currently; ongoing monitoring for safety issues recommended.

Genetic Factors: Limited data; pharmacogenomic considerations not well established.

Lab Test Interference: None specified.

Overdose Management

Signs/Symptoms: Severe hypertension, arrhythmias, chest pain, hypotension or hypertension depending on overdose.

Treatment: Discontinue infusion immediately; provide supportive care, administer vasodilators for hypertension, or vasopressors for hypotension as needed; consider magnesium sulfate for arrhythmias.

Storage and Handling

Storage: Store at controlled room temperature, 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions; use within the stability period after preparation.