Dobutamine

What is it?

Dobutamine is an inotrope that causes vasodilation. It is predominantly affects beta-1 receptors, and also reduces left ventricular filling pressure. However there are minimal beta-2 affects which results in overall vasodilation. The net effect is increased CO, with decreased SVR with or without a small reduction in blood pressure (Manaker, 2016).

Normal Dosages
  • Standard Drip: 250mg/250ml
  • Concentration: 1000mcg/mL
  • Dosing Range: 1-20mcg/kg/min
  • Max dose: 40 mcg/kg/min. Heart failure guidelines and the Surviving Sepsis Campaign recommend a maximum dose of 20 mcg/kg/minute (ACCF/AHA [Yancy 2013]; SCCM [Dellinger 2013]).
Consideration
  • Dobutamine does not selectively vasodilate the renal vascular bed, as dopamine does at low doses.
  • Dobutamine is contraindicated in the setting of idiopathic hypertrophic subaortic stenosis.
  • Patients receiving MOAI’s are extremely sensitive to vasopressors and therefore require much lower doses.
Pharmacodynamics
  • Onset of action: 1-10 minutes
  • Peak Effect: 10-20 minutes
  • Half-Life: 2 minutes
  • Metabolized By: Tissue & Liver
Hemodynamic Effects
  • HR: Increase
  • CO: Increase
  • PCW: Decrease
  • CVP: Decrease
  • SVR: Decrease
  • BP: An increase in BP is more common due to augmented CO, but occasionally a patient may become hypotensive (Lexicomp)
Adverse Reactions
  • Central nervous system: Headache (1% to 3%), paresthesia
  • Endocrine & metabolic: Decreased serum potassium (slight)
  • Gastrointestinal: Nausea (1% to 3%)
  • Respiratory: Dyspnea (1% to 3%)
  • Miscellaneous: Fever (1% to 3%)
  • Neuromuscular & skeletal: Leg cramps (mild)
References

Manaker, S. (2016, August 8). Use of vasopressors and inotropes. In UpToDate. Retrieved August 15, 2016, from https://www.uptodate.com/contents/use-of-vasopressors-and-inotropes?source=machineLearning&search=Dobutamine&selectedTitle=10~148§ionRank=1&anchor=H21#H21